Provider Demographics
NPI:1063816445
Name:CIRCLE OF LOVE NETWORK
Entity Type:Organization
Organization Name:CIRCLE OF LOVE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-203-5975
Mailing Address - Street 1:9105 ALANBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-5167
Mailing Address - Country:US
Mailing Address - Phone:682-203-5975
Mailing Address - Fax:
Practice Address - Street 1:9105 ALANBROOKE CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-5167
Practice Address - Country:US
Practice Address - Phone:682-203-5975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X, 347B00000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle