Provider Demographics
NPI:1447333455
Name:FULL CIRCLE SERVICES
Entity type:Organization
Organization Name:FULL CIRCLE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-334-4341
Mailing Address - Street 1:2349 JAMESTOWN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9709
Mailing Address - Country:US
Mailing Address - Phone:319-334-4341
Mailing Address - Fax:319-334-4314
Practice Address - Street 1:2349 JAMESTOWN AVE STE 1
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9709
Practice Address - Country:US
Practice Address - Phone:319-334-4341
Practice Address - Fax:319-334-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251B00000X, 251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0457283Medicaid
IA1457291Medicaid
IA0457291Medicaid