Provider Demographics
NPI:1841783289
Name:CIRCLE OF LIFE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE THERAPY SERVICES LLC
Other - Org Name:CIRCLE OF LIFE THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS IN PSYCH
Authorized Official - Phone:641-344-8567
Mailing Address - Street 1:1001 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-3008
Mailing Address - Country:US
Mailing Address - Phone:641-344-8567
Mailing Address - Fax:
Practice Address - Street 1:1001 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-3008
Practice Address - Country:US
Practice Address - Phone:641-344-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIRCLE OF LIFE THERAPY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========Medicaid