Provider Demographics
NPI:1851085815
Name:FULL 360
Entity Type:Organization
Organization Name:FULL 360
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-718-6304
Mailing Address - Street 1:946 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1633 KEELER AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-4713
Practice Address - Country:US
Practice Address - Phone:608-718-6304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty