Provider Demographics
NPI:1184760050
Name:CIRCLE OF LIGHT LLC
Entity type:Organization
Organization Name:CIRCLE OF LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-790-3877
Mailing Address - Street 1:12050 NE 14TH AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6585
Mailing Address - Country:US
Mailing Address - Phone:305-527-8686
Mailing Address - Fax:
Practice Address - Street 1:12050 NE 14TH AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6585
Practice Address - Country:US
Practice Address - Phone:305-527-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid