=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831596535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIRCLE OF LOVE FAMILY CARE HOME LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2014
-----------------------------------------------------
Last Update Date | 12/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6604 HWY 264 EAST ALT.
-----------------------------------------------------
City | STANTONSBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27883-9203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-238-8054
-----------------------------------------------------
Fax | 252-238-8054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6604 HWY 264 EAST ALT.
-----------------------------------------------------
City | STANTONSBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27883-9203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-238-8054
-----------------------------------------------------
Fax | 252-238-8054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | MRS. JOYCE RENEE ADAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-238-8054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------