# FULL CIRCLE HEALTH CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578521084
- **Authorized official:** E. VICTORIA GROVER PA-C (CEO)
- **Authorized official phone:** (207) 764-7200

## Contact information

- **Practice address:** 167 ACADEMY ST STE C, PRESQUE ISLE, ME 04769-3167
- **Practice address phone:** (207) 764-7200
- **Practice address fax:** (207) 764-7204
- **Mailing address:** 167 ACADEMY ST STE C, PRESQUE ISLE, ME 04769-3167
- **Mailing address phone:** (207) 764-7200
- **Mailing address fax:** (207) 764-7204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 05/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3670329 | AETNA GRP \# | ME |
| 05 | — | 422610000 | — | ME |
| 01 | — | DC9845 | RAILROAD GRP \# | ME |