=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366231292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INCLUSIVE CARE COMMUNITY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2025
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 ALDERSMEAD RD
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23236-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-731-6128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 GRANITE SPRINGS RD
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23225-6430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-745-3711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID WARREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-731-6128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------