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General NPI Number Information
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NPI Number | 1801920111
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Entity Type | Organization
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Legal Business Name | CIRCLE OF LIFE HOME CARE ANISHINAABE, LLC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 4100 LEXINGTON AVE N STE 150
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City | SHOREVIEW
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State | MN
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Zip | 55126-3025
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Country | US
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Telephone | 612-871-2474
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Fax | 612-870-3874
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Provider Business Mailing Address
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Address Line | 4100 LEXINGTON AVE N STE 150
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City | SHOREVIEW
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State | MN
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Zip | 55126-3025
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Country | US
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Telephone | 612-871-2474
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Fax | 612-870-3874
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Authorized Official
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Title or Position | CEO
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Name | KATIE FLEURY
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Credential |
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Telephone | 612-871-2474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 03-091399-00-3
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License Number State | NM
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