MEDICARE: ABOVE & BEYOND FULL CIRCLE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528686789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE & BEYOND FULL CIRCLE CARE

Provider Business Mailing Address
First Line	:	731 DUVAL STATION RD STE 107-257
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0800
Country	:	US
Telephone Number	:	904-219-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 DUVAL STATION RD STE 107-257
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0800
Country	:	US
Telephone Number	:	904-219-9210
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	TERENA D HOOVER
Credential	:
Telephone Number	:	904-219-9210

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “ABOVE & BEYOND FULL CIRCLE CARE ” Practice Location

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