Provider Demographics
NPI:1376088518
Name:FULL CIRCLE HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:FULL CIRCLE HOME HEALTH CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:269-274-8212
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:BURR OAK
Mailing Address - State:MI
Mailing Address - Zip Code:49030-0022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BURR OAK
Practice Address - State:MI
Practice Address - Zip Code:49030-9405
Practice Address - Country:US
Practice Address - Phone:269-274-8212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care