Provider Demographics
NPI:1609142876
Name:CIRCLE OF LOVE COMPANION & HOME CARE SVS
Entity Type:Organization
Organization Name:CIRCLE OF LOVE COMPANION & HOME CARE SVS
Other - Org Name:SAME AS ABOVE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WARREN ROOTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-714-7692
Mailing Address - Street 1:2809 PURCELL PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2809 PURCELL PL
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4492
Practice Address - Country:US
Practice Address - Phone:804-714-7692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAW12055000253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care