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General NPI Number Information
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NPI Number | 1639943558
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Entity Type | Organization
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Legal Business Name | INCLUSIVE LLC - LIVING - SERIES 2
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 2145 CAPE WAY
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City | NORTH FORT MYERS
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State | FL
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Zip | 33917-2505
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Country | US
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Telephone | 763-742-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 CAPE WAY
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City | NORTH FORT MYERS
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State | FL
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Zip | 33917-2505
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Country | US
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Telephone | 763-742-0612
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MARK EARL FELLING
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Credential |
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Telephone | 302-308-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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