Provider Demographics
NPI:1386755460
Name:CIRCLE OF LIFE
Entity type:Organization
Organization Name:CIRCLE OF LIFE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-750-6632
Mailing Address - Street 1:901 JONES RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0875
Mailing Address - Country:US
Mailing Address - Phone:479-750-6632
Mailing Address - Fax:479-750-6622
Practice Address - Street 1:901 JONES RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0875
Practice Address - Country:US
Practice Address - Phone:479-750-6632
Practice Address - Fax:479-750-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4315251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141380747Medicaid
AR146687764Medicaid
AR041529Medicare Oscar/Certification
AR146687764Medicaid