Provider Demographics
NPI:1942865878
Name:FULL HEALTH WELLNESS SYSTEMS
Entity Type:Organization
Organization Name:FULL HEALTH WELLNESS SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-283-2072
Mailing Address - Street 1:100 S PREWITT ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1760
Mailing Address - Country:US
Mailing Address - Phone:417-283-2072
Mailing Address - Fax:417-283-2073
Practice Address - Street 1:100 S PREWITT ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1760
Practice Address - Country:US
Practice Address - Phone:417-283-2072
Practice Address - Fax:417-283-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No253Z00000XAgenciesIn Home Supportive Care