MEDICARE: CIRCLES OF CARING ADULT DAY HEALTH FOUNDATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023433927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLES OF CARING ADULT DAY HEALTH FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	225 E PALOUSE RIVER DR
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-8915
Country	:	US
Telephone Number	:	208-883-6483
Fax Number	:	208-883-6489

Provider Business Practice Location Address
First Line	:	225 E PALOUSE RIVER DR
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-8915
Country	:	US
Telephone Number	:	208-883-6483
Fax Number	:	208-883-6489

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BARBARA ANNE MAHONEY
Credential	:	OTR/L
Telephone Number	:	208-883-6483

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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