MEDICARE: CIRCLES OF LIFE RESIDENTIAL CARE II, LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1295300242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLES OF LIFE RESIDENTIAL CARE II, LLC

Provider Business Mailing Address
First Line	:	PO BOX 978
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2268 W PEGGY DR
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-6682
Country	:	US
Telephone Number	:	480-676-3513
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CONNIE EDMONDS
Credential	:
Telephone Number	:	480-676-3513

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

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