Provider Demographics
NPI:1780003020
Name:CIRCLE OF LOVE , INC
Entity Type:Organization
Organization Name:CIRCLE OF LOVE , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WOOIYI
Authorized Official - Middle Name:
Authorized Official - Last Name:YIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-612-1388
Mailing Address - Street 1:5522 NEW PEACHTREE RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2543
Mailing Address - Country:US
Mailing Address - Phone:770-454-7979
Mailing Address - Fax:770-217-4086
Practice Address - Street 1:5522 NEW PEACHTREE RD STE 120-129
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2543
Practice Address - Country:US
Practice Address - Phone:770-454-7979
Practice Address - Fax:770-217-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2014 NONPS-0077261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA189317268AMedicaid
GA844538317AMedicaid
GA844538317AOtherMEDICARE PROVIDER ID