Healthcare Provider Details

I. General information

NPI: 1518191121
Provider Name (Legal Business Name): COMMUNITY INCLUSION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 STELLER WAY
KODIAK AK
99615-6490
US

IV. Provider business mailing address

PO BOX 147
KODIAK AK
99615-0147
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-3995
  • Fax:
Mailing address:
  • Phone: 907-486-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDY PLETNIKOFF
Title or Position: DIRECTOR
Credential:
Phone: 907-486-3995