Provider Demographics
NPI:1073006292
Name:INCLUSION CARE COORDINATION, LLC
Entity Type:Organization
Organization Name:INCLUSION CARE COORDINATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-635-1543
Mailing Address - Street 1:9687 MORAINE WAY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8710
Mailing Address - Country:US
Mailing Address - Phone:907-635-1543
Mailing Address - Fax:888-522-6841
Practice Address - Street 1:9687 MORAINE WAY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8710
Practice Address - Country:US
Practice Address - Phone:907-635-1543
Practice Address - Fax:888-522-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1644711Medicaid
AK1684397Medicaid