=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871056242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIRCLE OF LIFE HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2019
-----------------------------------------------------
Last Update Date | 04/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 THIMBLE SHOALS BLVD STE 301
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-599-0218
-----------------------------------------------------
Fax | 757-596-1794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 THIMBLE SHOALS BLVD STE 301
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-599-0218
-----------------------------------------------------
Fax | 757-596-1794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. JEANIA GRANDISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-599-0218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------