Provider Demographics
NPI:1942852074
Name:FULL CIRCLE RECOVERY
Entity Type:Organization
Organization Name:FULL CIRCLE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-737-6199
Mailing Address - Street 1:1860 LAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3614
Mailing Address - Country:US
Mailing Address - Phone:951-737-6199
Mailing Address - Fax:877-963-6329
Practice Address - Street 1:139 TRAKEHNER PL
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-5153
Practice Address - Country:US
Practice Address - Phone:951-737-6199
Practice Address - Fax:877-963-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330141BNOtherDHCS