Provider Demographics
NPI:1871056242
Name:CIRCLE OF LIFE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-599-0218
Mailing Address - Street 1:610 THIMBLE SHOALS BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2573
Mailing Address - Country:US
Mailing Address - Phone:757-599-0218
Mailing Address - Fax:757-596-1794
Practice Address - Street 1:610 THIMBLE SHOALS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2573
Practice Address - Country:US
Practice Address - Phone:757-599-0218
Practice Address - Fax:757-596-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health