Provider Demographics
NPI:1518191121
Name:COMMUNITY INCLUSION SERVICES
Entity Type:Organization
Organization Name:COMMUNITY INCLUSION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLETNIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-486-3995
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-0147
Mailing Address - Country:US
Mailing Address - Phone:907-486-3995
Mailing Address - Fax:
Practice Address - Street 1:914 STELLER WAY
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6490
Practice Address - Country:US
Practice Address - Phone:907-486-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care