Provider Demographics
NPI:1235782749
Name:ELDERCIRCLE
Entity Type:Organization
Organization Name:ELDERCIRCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-999-9233
Mailing Address - Street 1:400 RIVER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3784
Mailing Address - Country:US
Mailing Address - Phone:218-999-9233
Mailing Address - Fax:218-999-7543
Practice Address - Street 1:400 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3784
Practice Address - Country:US
Practice Address - Phone:218-999-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care