Provider Demographics
NPI:1518256155
Name:FULL CIRCLE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:FULL CIRCLE HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:207-764-7200
Mailing Address - Street 1:180 ACADEMY ST
Mailing Address - Street 2:STE 5
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-764-7200
Mailing Address - Fax:207-764-7204
Practice Address - Street 1:1063 ALLAGASH RD
Practice Address - Street 2:STE 1
Practice Address - City:ALLAGASH
Practice Address - State:ME
Practice Address - Zip Code:04774-4010
Practice Address - Country:US
Practice Address - Phone:207-398-1022
Practice Address - Fax:207-764-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health