Provider Demographics
NPI:1891061115
Name:FULLCIRCLE SUPPORTS, INC.
Entity Type:Organization
Organization Name:FULLCIRCLE SUPPORTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCNEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-485-4005
Mailing Address - Street 1:6 STODDARD LN
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1429
Mailing Address - Country:US
Mailing Address - Phone:207-620-7196
Mailing Address - Fax:
Practice Address - Street 1:6 STODDARD LN
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1429
Practice Address - Country:US
Practice Address - Phone:207-620-7196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME636428251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME636428OtherMAINE CAEW