Healthcare Provider Details

I. General information

NPI: 1164358594
Provider Name (Legal Business Name): AMMGW INC., D/B/A FULL CIRCLE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 OKLAND AVENUE
STATEN ISLAND NY
10310
US

IV. Provider business mailing address

191 OLYMPIA BLVD
STATEN ISLAND NY
10305-4223
US

V. Phone/Fax

Practice location:
  • Phone: 347-242-1770
  • Fax:
Mailing address:
  • Phone: 347-242-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNA MENDEZ
Title or Position: CEO
Credential: CASAC ADV, BS
Phone: 347-242-1770