MEDICARE: FULL CIRCLE HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HPO122400	NJ

General Provider Information

NPI Number	:	1194965434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1460 MORRIS AVE
Second Line	:	SUITE 2(A) & 2(B)
City	:	UNION
State	:	NJ
Zip	:	07083-3337
Country	:	US
Telephone Number	:	908-624-1005
Fax Number	:	908-624-1010

Provider Business Practice Location Address
First Line	:	1460 MORRIS AVE
Second Line	:	SUITE 2(A) & 2(B)
City	:	UNION
State	:	NJ
Zip	:	07083-3337
Country	:	US
Telephone Number	:	908-624-1005
Fax Number	:	908-624-1010

Authorized Official
Title or Position	:	CEO
Name	:	MR. DUANE OXFORD
Credential	:
Telephone Number	:	908-624-1005

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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