MEDICARE: ALL INCLUSIVE COMMUNITY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1265364731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL INCLUSIVE COMMUNITY SERVICES LLC

Provider Business Mailing Address
First Line	:	2416 N 188TH TER
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-5813
Country	:	US
Telephone Number	:	317-748-9436
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S RIVERSIDE DR # 21
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-5611
Country	:	US
Telephone Number	:	317-748-9436
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	REGIS GUEDEGBE
Credential	:
Telephone Number	:	317-748-9436

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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