MEDICARE: CIRCLES OF CARE, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	3104A0625X	Assisted Living Facility (Mental Illness)	8550	FL
4	323P00000X	Psychiatric Residential Treatment Facility	8599	FL
5	283Q00000X	Psychiatric Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028661	OTHER	FL	VALUE OPTIONS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00795	OTHER	FL	BLUE SHIELD
5	E90	OTHER	FL	BLUE CROSS

NPI Number	:	1679541031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLES OF CARE, INC.

Provider Business Mailing Address
First Line	:	400 E SHERIDAN RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3184
Country	:	US
Telephone Number	:	321-722-5200
Fax Number	:	321-722-5230

Provider Business Practice Location Address
First Line	:	400 E SHERIDAN RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3184
Country	:	US
Telephone Number	:	321-722-5200
Fax Number	:	321-722-5230

Authorized Official
Title or Position	:	VICE PRESIDENT HUMAN RELATIONS
Name	:	FALLON DEROSA
Credential	:
Telephone Number	:	321-722-5273

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	04/16/2024