Provider Demographics
NPI:1770310278
Name:CIRCLE OF LIFE HEALING INC
Entity type:Organization
Organization Name:CIRCLE OF LIFE HEALING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCOEUR
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 220
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8343
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:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center