Provider Demographics
NPI:1871588616
Name:CIRCLE OF LIFE COMMUNITY HOSPICE & PALLIATIVE CARE
Entity type:Organization
Organization Name:CIRCLE OF LIFE COMMUNITY HOSPICE & PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:866-258-3569
Mailing Address - Street 1:1210 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-1489
Mailing Address - Country:US
Mailing Address - Phone:866-258-3569
Mailing Address - Fax:866-258-3569
Practice Address - Street 1:1210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-1489
Practice Address - Country:US
Practice Address - Phone:866-258-3569
Practice Address - Fax:866-258-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261608251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19224133OtherSTATE TAX ID
MOLC0634607OtherSECRETARY OF STATE
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