Provider Demographics
NPI:1972951671
Name:CIRCLE OF SUPPORT
Entity Type:Organization
Organization Name:CIRCLE OF SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-437-3363
Mailing Address - Street 1:103 DEVELIN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1505
Mailing Address - Country:US
Mailing Address - Phone:484-437-3363
Mailing Address - Fax:
Practice Address - Street 1:103 DEVELIN DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1505
Practice Address - Country:US
Practice Address - Phone:484-437-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services