Provider Demographics
NPI:1861807166
Name:CIRCLE CENTER ADULT DAY SERVICES
Entity type:Organization
Organization Name:CIRCLE CENTER ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-355-5717
Mailing Address - Street 1:4900 W MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3105
Mailing Address - Country:US
Mailing Address - Phone:804-355-5717
Mailing Address - Fax:804-358-3866
Practice Address - Street 1:4900 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3105
Practice Address - Country:US
Practice Address - Phone:804-355-5717
Practice Address - Fax:804-358-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087300320Medicaid