Provider Demographics
NPI:1174902902
Name:THE CIRCLE OF VETERANS AND FAMILIES, INC.
Entity type:Organization
Organization Name:THE CIRCLE OF VETERANS AND FAMILIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-859-9006
Mailing Address - Street 1:19717 BOWER RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-6867
Mailing Address - Country:US
Mailing Address - Phone:773-859-9006
Mailing Address - Fax:727-499-7526
Practice Address - Street 1:19717 BOWER RD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-6867
Practice Address - Country:US
Practice Address - Phone:773-859-9006
Practice Address - Fax:727-499-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5540320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness