Provider Demographics
NPI:1508463654
Name:FULL CIRCLE HEALTH AND WELLNESS CENTER PLLP
Entity Type:Organization
Organization Name:FULL CIRCLE HEALTH AND WELLNESS CENTER PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-560-3928
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0922
Mailing Address - Country:US
Mailing Address - Phone:509-560-3928
Mailing Address - Fax:
Practice Address - Street 1:208 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9755
Practice Address - Country:US
Practice Address - Phone:509-560-3928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1942821277OtherNPI
WA1699336636OtherNIP
WA1790123123OtherNPI