Provider Demographics
NPI:1467801837
Name:CIRCLE OF FRIENDS COMMUNITY
Entity Type:Organization
Organization Name:CIRCLE OF FRIENDS COMMUNITY
Other - Org Name:CIRCLE OF FRINEDS COMMUNITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSWALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-280-7717
Mailing Address - Street 1:3256 S GRANBY WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3839
Mailing Address - Country:US
Mailing Address - Phone:720-280-7717
Mailing Address - Fax:
Practice Address - Street 1:3256 S GRANBY WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3839
Practice Address - Country:US
Practice Address - Phone:720-280-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care