Provider Demographics
NPI:1134823560
Name:CIRCLE OF LIFE CAREGIVER CORPORATIVE
Entity type:Organization
Organization Name:CIRCLE OF LIFE CAREGIVER CORPORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-647-1537
Mailing Address - Street 1:1155 N STATE ST STE 508
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5064
Mailing Address - Country:US
Mailing Address - Phone:360-647-1537
Mailing Address - Fax:360-647-1540
Practice Address - Street 1:1155 N STATE ST STE 508
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5064
Practice Address - Country:US
Practice Address - Phone:360-647-1537
Practice Address - Fax:360-647-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health