Healthcare Provider Details

I. General information

NPI: 1639943558
Provider Name (Legal Business Name): INCLUSIVE LLC - LIVING - SERIES 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CAPE WAY
NORTH FORT MYERS FL
33917-2505
US

IV. Provider business mailing address

2145 CAPE WAY
NORTH FORT MYERS FL
33917-2505
US

V. Phone/Fax

Practice location:
  • Phone: 763-742-0612
  • Fax:
Mailing address:
  • Phone: 763-742-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK EARL FELLING
Title or Position: MANAGER
Credential:
Phone: 302-308-4008