Healthcare Provider Details

I. General information

NPI: 1255256822
Provider Name (Legal Business Name): FULL CIRCLE DISABILITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 S PRAIRIE AVE
CHICAGO IL
60653-3376
US

IV. Provider business mailing address

4414 S PRAIRIE AVE
CHICAGO IL
60653-3376
US

V. Phone/Fax

Practice location:
  • Phone: 702-574-0272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHIMEZIE MADUKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-574-0272