Organization
FULL POTENTIAL. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA SUE CHURCH (PRESIDENT)
(260) 499-0359
Entity
Organization
Contact information
Practice address
700 W TOLEDO ST, P.O 187, FREMONT, IN 46737-7606
(260) 499-0359
Mailing address
700 W TOLEDO ST, P.O 187, FREMONT, IN 46737-7606
(260) 499-0359
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201404030-A
—
IN
Enumeration date
12/21/2016
Last updated
12/21/2016
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