Provider Demographics
NPI:1801920111
Name:CIRCLE OF LIFE HOME CARE ANISHINAABE, LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE HOME CARE ANISHINAABE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-871-2474
Mailing Address - Street 1:4100 LEXINGTON AVE N STE 150
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3025
Mailing Address - Country:US
Mailing Address - Phone:612-871-2474
Mailing Address - Fax:612-870-3874
Practice Address - Street 1:4100 LEXINGTON AVE N STE 150
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-3025
Practice Address - Country:US
Practice Address - Phone:612-871-2474
Practice Address - Fax:612-870-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X
NM03-091399-00-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT05835739Medicaid
CO1801920111Medicaid
AZ233426Medicaid
NM43733034Medicaid
MN18010920111Medicaid