Provider Demographics
NPI:1407069438
Name:INCLUSION NORTH, INC
Entity Type:Organization
Organization Name:INCLUSION NORTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-888-1758
Mailing Address - Street 1:880 E FRANKLIN RD
Mailing Address - Street 2:#303
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6099
Mailing Address - Country:US
Mailing Address - Phone:208-888-1758
Mailing Address - Fax:208-895-8001
Practice Address - Street 1:213 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2700
Practice Address - Country:US
Practice Address - Phone:208-883-8041
Practice Address - Fax:208-882-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8052062Medicaid