MEDICARE: CIRCLE OF LIGHT 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780544353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE OF LIGHT LLC

Provider Business Mailing Address
First Line	:	116 GRANVILLE ST STE 101
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-3044
Country	:	US
Telephone Number	:	380-400-3583
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 GRANVILLE ST STE 101
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-3044
Country	:	US
Telephone Number	:	380-400-3583
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MERCEDES BENNETT
Credential	:
Telephone Number	:	614-371-1409

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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Directions to “CIRCLE OF LIGHT LLC ” Practice Location

Language	Start Address	Practice Location

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