Provider Demographics
NPI:1114904182
Name:HOSPICE CIRCLE OF LOVE ASSOCIATION
Entity Type:Organization
Organization Name:HOSPICE CIRCLE OF LOVE ASSOCIATION
Other - Org Name:HOSPICE CIRCLE OF LOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-234-2273
Mailing Address - Street 1:314 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5736
Mailing Address - Country:US
Mailing Address - Phone:580-234-2273
Mailing Address - Fax:580-234-1990
Practice Address - Street 1:314 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5736
Practice Address - Country:US
Practice Address - Phone:580-234-2273
Practice Address - Fax:580-234-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4014251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4014OtherOK STATE HOSPICE LICENSE
OK371501Medicare ID - Type UnspecifiedHOSPICE