Provider Demographics
NPI:1164267373
Name:FULL CIRCLE HEALTH, INC.
Entity type:Organization
Organization Name:FULL CIRCLE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-514-2512
Mailing Address - Street 1:777 N RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9251
Mailing Address - Country:US
Mailing Address - Phone:208-514-2500
Mailing Address - Fax:
Practice Address - Street 1:315 E ELM ST # 201
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4857
Practice Address - Country:US
Practice Address - Phone:208-954-8707
Practice Address - Fax:208-954-8708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULL CIRCLE HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy