Provider Demographics
NPI:1649029067
Name:FULL CIRCLE HEALTH LLC
Entity type:Organization
Organization Name:FULL CIRCLE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:803-669-5616
Mailing Address - Street 1:1119 PEPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9655
Mailing Address - Country:US
Mailing Address - Phone:803-669-5616
Mailing Address - Fax:
Practice Address - Street 1:1119 PEPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9655
Practice Address - Country:US
Practice Address - Phone:803-669-5616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty