Organization
CIRCLE OF ANGELS RESIDENTIAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACRISTA WATERMAN (OWNER)
(330) 431-1329
Entity
Organization
Contact information
Practice address
146 S MILLER RD, FAIRLAWN, OH 44333-4110
(330) 431-1329
Mailing address
146 S MILLER RD, FAIRLAWN, OH 44333-4110
(330) 431-1329
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0086006
—
OH
Enumeration date
12/04/2014
Last updated
12/04/2014
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