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General NPI Number Information
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NPI Number | 1346785722
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Entity Type | Organization
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Legal Business Name | FULL POTENTIAL. INC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 700 W TOLEDO ST P.O 187
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City | FREMONT
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State | IN
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Zip | 46737-7606
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Country | US
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Telephone | 260-499-0359
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W TOLEDO ST P.O 187
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City | FREMONT
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State | IN
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Zip | 46737-7606
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Country | US
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Telephone | 260-499-0359
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CYNTHIA SUE CHURCH
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Credential |
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Telephone | 260-499-0359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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