Provider Demographics
NPI:1841024866
Name:CIRCLE OF LIFE SERVICES LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLORISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-721-1998
Mailing Address - Street 1:25415 COX RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-6509
Mailing Address - Country:US
Mailing Address - Phone:804-721-1998
Mailing Address - Fax:
Practice Address - Street 1:25415 COX RD
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-6509
Practice Address - Country:US
Practice Address - Phone:804-721-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care