Provider Demographics
NPI:1053760926
Name:CIRCLE OF LIFE MIHP LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE MIHP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-673-6860
Mailing Address - Street 1:23403 HAIG ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3425
Mailing Address - Country:US
Mailing Address - Phone:734-673-6860
Mailing Address - Fax:
Practice Address - Street 1:23403 HAIG ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3425
Practice Address - Country:US
Practice Address - Phone:734-673-6860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health