Healthcare Provider Details

I. General information

NPI: 1336503606
Provider Name (Legal Business Name): FULL CIRCLE ADULT DAY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 E. LINDSEY PLAZA DRIVE
NORMAN OK
73071
US

IV. Provider business mailing address

1304 E. LINDSEY PLAZA DRIVE
NORMAN OK
73071
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-2955
  • Fax: 405-701-0546
Mailing address:
  • Phone: 405-447-2955
  • Fax: 405-701-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC1401-1401
License Number StateOK

VIII. Authorized Official

Name: MRS. PATRICIA L. INGRAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-447-2955