Healthcare Provider Details

I. General information

NPI: 1730632977
Provider Name (Legal Business Name): FAMILY CIRCLES HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 07/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GREAT MOOSE DR
HARTLAND ME
04943-3022
US

IV. Provider business mailing address

10 GREAT MOOSE DR
HARTLAND ME
04943-3022
US

V. Phone/Fax

Practice location:
  • Phone: 207-735-7807
  • Fax: 207-512-1133
Mailing address:
  • Phone: 207-735-7807
  • Fax: 207-512-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberCNP81850
License Number StateME

VIII. Authorized Official

Name: MRS. JENNIFER ELIZABETH BAGLEY
Title or Position: OWNER/OPERATOR
Credential: FNP-C
Phone: 207-735-7807