Provider Demographics
NPI:1336503606
Name:FULL CIRCLE ADULT DAY CENTER, INC
Entity Type:Organization
Organization Name:FULL CIRCLE ADULT DAY CENTER, INC
Other - Org Name:FULL CIRCLE ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-447-2955
Mailing Address - Street 1:1304 E. LINDSEY PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071
Mailing Address - Country:US
Mailing Address - Phone:405-447-2955
Mailing Address - Fax:405-701-0546
Practice Address - Street 1:1304 E. LINDSEY PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-447-2955
Practice Address - Fax:405-701-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC1401-1401261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care