Provider Demographics
NPI:1578521084
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 1:167 ACADEMY ST STE C
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3167
Mailing Address - Country:US
Mailing Address - Phone:207-764-7200
Mailing Address - Fax:207-764-7204
Practice Address - Street 1:167 ACADEMY ST STE C
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3167
Practice Address - Country:US
Practice Address - Phone:207-764-7200
Practice Address - Fax:207-764-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME422610000Medicaid
MEDC9845OtherRAILROAD GRP #
ME3670329OtherAETNA GRP #
ME422610000Medicaid
ME6211750001Medicare NSC
ME422610000Medicaid