Provider Demographics
NPI:1356174783
Name:CIRCLE OF LIFE TREATMENT CENTER
Entity type:Organization
Organization Name:CIRCLE OF LIFE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MBWAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-424-7073
Mailing Address - Street 1:3951 N HAVERHILL RD STE 219
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8342
Mailing Address - Country:US
Mailing Address - Phone:561-424-7073
Mailing Address - Fax:
Practice Address - Street 1:3951 N HAVERHILL RD STE 219
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8342
Practice Address - Country:US
Practice Address - Phone:561-424-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center