Provider Demographics
NPI:1780186759
Name:CIRCLE HEALTH SERVICES
Entity Type:Organization
Organization Name:CIRCLE HEALTH SERVICES
Other - Org Name:THE FREE MEDICAL CLINIC OF GREATER CLEVELAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-303-6026
Mailing Address - Street 1:3929 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4153
Mailing Address - Country:US
Mailing Address - Phone:212-252-5800
Mailing Address - Fax:
Practice Address - Street 1:3929 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4153
Practice Address - Country:US
Practice Address - Phone:212-252-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114180Medicaid