Provider Demographics
NPI:1528579596
Name:FULL CIRCLE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:FULL CIRCLE HEALTH AND WELLNESS LLC
Other - Org Name:FULL CIRCLE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:575-513-7696
Mailing Address - Street 1:1702 W GILCHRIST AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1100
Mailing Address - Country:US
Mailing Address - Phone:755-137-6965
Mailing Address - Fax:866-516-1214
Practice Address - Street 1:1702 W GILCHRIST AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1100
Practice Address - Country:US
Practice Address - Phone:330-696-9129
Practice Address - Fax:866-516-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service