Provider Demographics
NPI:1063741627
Name:CIRCLE OF FRIENDS HOME HEALTH CARE LLC..
Entity type:Organization
Organization Name:CIRCLE OF FRIENDS HOME HEALTH CARE LLC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYZA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:630-417-8216
Mailing Address - Street 1:7848 W ODGEN AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1389
Mailing Address - Country:US
Mailing Address - Phone:630-417-8216
Mailing Address - Fax:630-427-1667
Practice Address - Street 1:7848 W ODGEN AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1389
Practice Address - Country:US
Practice Address - Phone:630-417-8216
Practice Address - Fax:630-427-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1944388251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health