1750155685 NPI number — INCLUSIVE LLC - TECHNOLOGIES - SERIES 1

Table of content: (NPI 1750155685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750155685 NPI number — INCLUSIVE LLC - TECHNOLOGIES - SERIES 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INCLUSIVE LLC - TECHNOLOGIES - SERIES 1
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750155685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 CAPE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33917-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-742-0612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2145 CAPE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33917-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-742-0612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FELLING
Authorized Official First Name:
MARK
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
302-308-4008

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171WV0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224ZE0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225CA2400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XE0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XR0403X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225CA2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)