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General NPI Number Information
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NPI Number | 1891061115
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Entity Type | Organization
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Legal Business Name | FULLCIRCLE SUPPORTS, INC.
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 6 STODDARD LN
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City | HALLOWELL
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State | ME
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Zip | 04347-1429
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Country | US
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Telephone | 207-620-7196
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Fax |
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Provider Business Mailing Address
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Address Line | 6 STODDARD LN
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City | HALLOWELL
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State | ME
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Zip | 04347-1429
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Country | US
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Telephone | 207-620-7196
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARK EDWARD MCNEFF
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Credential |
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Telephone | 207-485-4005
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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 | 636428
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 636428
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License Number State | ME
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