Healthcare Provider Details

I. General information

NPI: 1649983495
Provider Name (Legal Business Name): FULL CIRCLE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 ESPEY CT STE 2
CROFTON MD
21114-2474
US

IV. Provider business mailing address

2131 ESPEY CT STE 2
CROFTON MD
21114-2474
US

V. Phone/Fax

Practice location:
  • Phone: 410-487-4300
  • Fax:
Mailing address:
  • Phone: 410-487-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANELL NICOLE JACOBS
Title or Position: OWNER
Credential:
Phone: 410-487-4300