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General NPI Number Information
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NPI Number | 1497047666
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Entity Type | Organization
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Legal Business Name | CIRCLE OF LOVE
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 6722 JAYCROSS RD
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City | FREMONT
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State | NC
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Zip | 27830-9418
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Country | US
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Telephone | 252-281-4755
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Fax |
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Provider Business Mailing Address
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Address Line | 6722 JAYCROSS RD
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City | FREMONT
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State | NC
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Zip | 27830-9418
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Country | US
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Telephone | 252-281-4755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOYCE RENEE ADAMS
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Credential |
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Telephone | 252-281-4577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL098160
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License Number State | NC
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