# FULLER LIFE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1780329524
- **Authorized official:** STEVEN FULLER (OWNER)
- **Authorized official phone:** (480) 286-0568

## Contact information

- **Practice address:** 10720 W INDIAN SCHOOL RD \# 19-154, PHOENIX, AZ 85037-5721
- **Practice address phone:** (480) 286-0568
- **Mailing address:** 10720 W INDIAN SCHOOL RD \# 19-154, PHOENIX, AZ 85037-5721
- **Mailing address phone:** (480) 286-0568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/04/2022
- **Last updated:** 05/04/2022