Provider Demographics
NPI:1861003444
Name:CIRCLE OF SUPPORTS INC.
Entity Type:Organization
Organization Name:CIRCLE OF SUPPORTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AKILI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANJO-YEOBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-630-0650
Mailing Address - Street 1:718 CLOPPER RD APT 34
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1333
Mailing Address - Country:US
Mailing Address - Phone:240-630-0650
Mailing Address - Fax:
Practice Address - Street 1:718 CLOPPER RD APT 34
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1333
Practice Address - Country:US
Practice Address - Phone:240-630-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty