Provider Demographics
NPI:1639943558
Name:INCLUSIVE LLC - LIVING - SERIES 2
Entity Type:Organization
Organization Name:INCLUSIVE LLC - LIVING - SERIES 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:FELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-308-4008
Mailing Address - Street 1:2145 CAPE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-2505
Mailing Address - Country:US
Mailing Address - Phone:763-742-0612
Mailing Address - Fax:
Practice Address - Street 1:2145 CAPE WAY
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-2505
Practice Address - Country:US
Practice Address - Phone:763-742-0612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INCLUSIVE ADVENTURES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care