Provider Demographics
NPI:1346492063
Name:CIRCLE OF LIFE INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:CIRCLE OF LIFE INTERNATIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEAN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-299-8912
Mailing Address - Street 1:14533 WESTGREEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-0611
Mailing Address - Country:US
Mailing Address - Phone:704-299-8912
Mailing Address - Fax:704-948-6033
Practice Address - Street 1:14533 WESTGREEN DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-0611
Practice Address - Country:US
Practice Address - Phone:704-299-8912
Practice Address - Fax:704-948-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10422038OtherVOCATIONAL REHABILITATION SERVICES