Fuller Life LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

FULLER LIFE LLC

Practice address

10720 W Indian School Rd # 19-154
Phoenix, AZ 85037-5721

Phone

(480) 286-0568

NPI assigned

May 4, 2022

Last updated

May 4, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steven Fuller

Title

Owner

Phone

(480) 286-0568

Specialties & licenses 2

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1780329524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10720 W INDIAN SCHOOL RD # 19-154",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375721",
            "telephone_number": "480-286-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10720 W INDIAN SCHOOL RD # 19-154",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375721",
            "telephone_number": "480-286-0568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-286-0568"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "FULLERLIFEBUSINESS@YAHOO.COM",
            "affiliation": "N",
            "address_1": "10720 W Indian School Rd # 19-154",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850375721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Timothy Richard Fullam, M.D.
• Alexandra Fulleman, PA-C
• Fuller Theological Seminary
• Aaron Bryce Fuller, COTA
• Bryan L Fuller, O.D.
• Carolyn M Fuller, ND
• Jennifer Fuller

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.