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General NPI Number Information
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NPI Number | 1295551653
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Entity Type | Organization
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Legal Business Name | CORE COMMUNITY CIRCLE, LLC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1508 FAWN RUN XING
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City | NORMAN
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State | OK
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Zip | 73071-9717
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Country | US
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Telephone | 405-408-5297
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 FAWN RUN XING
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City | NORMAN
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State | OK
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Zip | 73071-9717
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Country | US
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Telephone | 405-408-5297
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GLADYS YELUMA JANGHA
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Credential | RN.
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Telephone | 405-408-5297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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