Provider Demographics
NPI:1174382857
Name:CIRCLE OF LIFE HOMECARE AND CONSULTING GROUP LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE HOMECARE AND CONSULTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:CHARLENE RENE
Authorized Official - Last Name:ZACHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-633-6220
Mailing Address - Street 1:5444 CRENSHAW BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2408
Mailing Address - Country:US
Mailing Address - Phone:818-633-6220
Mailing Address - Fax:
Practice Address - Street 1:5025 11TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4815
Practice Address - Country:US
Practice Address - Phone:818-633-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility