Provider Demographics
NPI:1366209686
Name:CIRCLE OF LIFE ADULT FOSTER CARE LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE ADULT FOSTER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEKRALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:401-829-2654
Mailing Address - Street 1:200 HEROUX BLVD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-829-2654
Mailing Address - Fax:
Practice Address - Street 1:317 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769
Practice Address - Country:US
Practice Address - Phone:401-829-2654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health