Provider Demographics
NPI:1245631381
Name:CIRCLE OF FRIENDS HOME CARE
Entity type:Organization
Organization Name:CIRCLE OF FRIENDS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYZA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:630-417-8216
Mailing Address - Street 1:42 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6346
Mailing Address - Country:US
Mailing Address - Phone:630-417-8216
Mailing Address - Fax:
Practice Address - Street 1:42 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6346
Practice Address - Country:US
Practice Address - Phone:630-417-8216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000518253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care