Provider Demographics
NPI:1457752818
Name:CIRCLE OF LIFE HOSPICE
Entity Type:Organization
Organization Name:CIRCLE OF LIFE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:OVERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:405-432-5180
Mailing Address - Street 1:20 E 9TH ST # B30
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6909
Mailing Address - Country:US
Mailing Address - Phone:405-432-5180
Mailing Address - Fax:405-432-5181
Practice Address - Street 1:20 E 9TH ST # B30
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6909
Practice Address - Country:US
Practice Address - Phone:405-432-5180
Practice Address - Fax:405-432-5181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIRCLE OF LIFE HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-04
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4297251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4297OtherHOSPICE