Organization
FULLER LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN FULLER (OWNER)
(480) 286-0568
Entity
Organization
Contact information
Practice address
10720 W INDIAN SCHOOL RD # 19-154, PHOENIX, AZ 85037-5721
(480) 286-0568
Mailing address
10720 W INDIAN SCHOOL RD # 19-154, PHOENIX, AZ 85037-5721
(480) 286-0568
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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