Provider Demographics
NPI:1366076119
Name:EXCLUSIVELY INCUSIVE LLC
Entity type:Organization
Organization Name:EXCLUSIVELY INCUSIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITMARSH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMP
Authorized Official - Phone:907-251-0055
Mailing Address - Street 1:751 OLD RICHARDSON HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7802
Mailing Address - Country:US
Mailing Address - Phone:907-251-1331
Mailing Address - Fax:855-414-4818
Practice Address - Street 1:751 OLD RICHARDSON HWY STE 101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7802
Practice Address - Country:US
Practice Address - Phone:907-251-1331
Practice Address - Fax:855-414-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972160653OtherNPPES
1053769612OtherNPPES