=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780003020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIRCLE OF LOVE , INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2014
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5522 NEW PEACHTREE RD STE 120-129
-----------------------------------------------------
City | CHAMBLEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-2543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-454-7979
-----------------------------------------------------
Fax | 770-217-4086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5522 NEW PEACHTREE RD SUITE 129
-----------------------------------------------------
City | CHAMBLEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-2543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-454-7979
-----------------------------------------------------
Fax | 770-217-4086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | WOOIYI YIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-612-1388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 2014 NONPS-0077
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------