Provider Demographics
NPI:1396244679
Name:CIRCLE OF FRIENDS CARE
Entity type:Organization
Organization Name:CIRCLE OF FRIENDS CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ENA
Authorized Official - Middle Name:GWENTAIL
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:313-772-1661
Mailing Address - Street 1:14412 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2307
Mailing Address - Country:US
Mailing Address - Phone:313-261-2000
Mailing Address - Fax:313-731-0576
Practice Address - Street 1:19621 HANNA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1367
Practice Address - Country:US
Practice Address - Phone:313-772-1661
Practice Address - Fax:313-731-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7157793251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7157793Medicaid