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General NPI Number Information
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NPI Number | 1568328094
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Entity Type | Organization
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Legal Business Name | CIRCLE OF LIFE HOME CARE SERVICES, LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 25415 COX RD
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-6509
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Country | US
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Telephone | 804-712-1998
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Fax |
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Provider Business Mailing Address
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Address Line | 25415 COX RD
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-6509
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Country | US
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Telephone | 804-712-1998
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CLORISSE PETTAWAY
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Credential |
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Telephone | 804-712-1998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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