Provider Demographics
NPI:1114395456
Name:CIRCLE OF CARE, INC.
Entity Type:Organization
Organization Name:CIRCLE OF CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-615-2110
Mailing Address - Street 1:4402 LAWRENCEVILLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6781
Mailing Address - Country:US
Mailing Address - Phone:678-615-2110
Mailing Address - Fax:
Practice Address - Street 1:4402 LAWRENCEVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6781
Practice Address - Country:US
Practice Address - Phone:678-615-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA147R0246253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA381973026AMedicaid