Provider Demographics
NPI:1689771552
Name:CIRCLE OF LIFE HOSPICE, INC.
Entity Type:Organization
Organization Name:CIRCLE OF LIFE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LASTER
Authorized Official - Last Name:DOWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-518-3871
Mailing Address - Street 1:920 E 70TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-3400
Mailing Address - Country:US
Mailing Address - Phone:318-869-4012
Mailing Address - Fax:318-869-4024
Practice Address - Street 1:920 E 70TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-3400
Practice Address - Country:US
Practice Address - Phone:318-869-4012
Practice Address - Fax:318-869-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36269864D251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191634Medicare Oscar/Certification