Basic Information
| Provider Information | |||||||||
| NPI: | 1518256155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FULL CIRCLE HEALTH CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 ACADEMY ST | ||||||||
| Address2: | STE 5 | ||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077647200 | ||||||||
| FaxNumber: | 2077647204 | ||||||||
| Practice Location | |||||||||
| Address1: | 1063 ALLAGASH RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | ALLAGASH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047744010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073981022 | ||||||||
| FaxNumber: | 2077647204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 06/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | GROVER | ||||||||
| AuthorizedOfficialFirstName: | E. | ||||||||
| AuthorizedOfficialMiddleName: | VICTORIA | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2077647200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.A.-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.