Provider Demographics
NPI:1225321847
Name:OUR FAMILY CIRCLE
Entity Type:Organization
Organization Name:OUR FAMILY CIRCLE
Other - Org Name:CANAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/QUALITY IMPROVEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDD-GARCELON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-733-2552
Mailing Address - Street 1:225 FOXBOROUGH BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-0000
Mailing Address - Country:US
Mailing Address - Phone:508-618-7952
Mailing Address - Fax:774-215-5708
Practice Address - Street 1:99 GUION STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3001
Practice Address - Country:US
Practice Address - Phone:413-746-0777
Practice Address - Fax:413-746-0630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULT DAY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 261QA0600X
MA385H0000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090307AMedicaid