Provider Demographics
NPI:1245495266
Name:FULL CIRCLE WELLNES CENTER
Entity type:Organization
Organization Name:FULL CIRCLE WELLNES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-265-3400
Mailing Address - Street 1:1719 GIRARD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1718
Mailing Address - Country:US
Mailing Address - Phone:505-265-3400
Mailing Address - Fax:
Practice Address - Street 1:1719 GIRARD BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1718
Practice Address - Country:US
Practice Address - Phone:505-265-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A&M ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty