Provider Demographics
NPI:1154626844
Name:CIRCLE OF LIFE KOLA HOME CARE, LLC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE KOLA HOME CARE, LLC
Other - Org Name:KOLA CIRCLE OF LIFE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HIMMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-871-2474
Mailing Address - Street 1:1433 E FRANKLIN AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2101
Mailing Address - Country:US
Mailing Address - Phone:612-871-2474
Mailing Address - Fax:612-870-3874
Practice Address - Street 1:1433 E FRANKLIN AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2101
Practice Address - Country:US
Practice Address - Phone:612-871-2474
Practice Address - Fax:612-870-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND32190Medicaid
SD9558300Medicaid
NM43733034Medicaid