Provider Demographics
NPI:1285034140
Name:CIRCLE OF LIFE REHABILITATION SERVICES
Entity Type:Organization
Organization Name:CIRCLE OF LIFE REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LERONARD
Authorized Official - Suffix:
Authorized Official - Credentials:BA PSYCHOLOGY
Authorized Official - Phone:641-464-8058
Mailing Address - Street 1:112 W MADISON ST
Mailing Address - Street 2:P.O.BOX 604
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-1630
Mailing Address - Country:US
Mailing Address - Phone:641-464-8058
Mailing Address - Fax:641-464-8089
Practice Address - Street 1:112 W MADISON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-1630
Practice Address - Country:US
Practice Address - Phone:641-464-8058
Practice Address - Fax:641-464-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA253Z00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000109704Medicaid