Provider Demographics
NPI:1013779917
Name:ALLI INCLUSION SUPPORT SERVICES
Entity type:Organization
Organization Name:ALLI INCLUSION SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED SERVICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-413-1115
Mailing Address - Street 1:806 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2335
Mailing Address - Country:US
Mailing Address - Phone:208-413-1115
Mailing Address - Fax:
Practice Address - Street 1:806 3RD ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2335
Practice Address - Country:US
Practice Address - Phone:208-413-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management