Provider Demographics
NPI:1174915060
Name:TG CIRCLE OF LIFE LLC
Entity type:Organization
Organization Name:TG CIRCLE OF LIFE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:267-909-9248
Mailing Address - Street 1:1172 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3142
Mailing Address - Country:US
Mailing Address - Phone:267-909-9248
Mailing Address - Fax:
Practice Address - Street 1:427 W GIRARD AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1427
Practice Address - Country:US
Practice Address - Phone:267-909-9248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health