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General NPI Number Information
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NPI Number | 1790242006
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Entity Type | Organization
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Legal Business Name | CIRCLE OF SUPPORT LLC
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 29858 HANOVER BLVD
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City | WESTLAND
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State | MI
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Zip | 48186-5178
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Country | US
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Telephone | 404-434-0070
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Fax | 734-331-2364
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Provider Business Mailing Address
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Address Line | 29858 HANOVER BLVD
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City | WESTLAND
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State | MI
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Zip | 48186-5178
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Country | US
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Telephone | 404-434-0070
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Fax | 734-331-2364
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KENA GEE
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Credential |
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Telephone | 404-434-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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