Provider Demographics
NPI: | 1861882821 |
---|---|
Name: | INCLUSIVE SOLUTIONS LLC |
Entity type: | Organization |
Organization Name: | INCLUSIVE SOLUTIONS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | DELL |
Authorized Official - Last Name: | ELLIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 313-676-0013 |
Mailing Address - Street 1: | 26721 ANN ARBOR TRL |
Mailing Address - Street 2: | |
Mailing Address - City: | DEARBORN HEIGHTS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48127-1001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 313-676-0013 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4535 CHRYSLER DR |
Practice Address - Street 2: | |
Practice Address - City: | DETROIT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48201-1954 |
Practice Address - Country: | US |
Practice Address - Phone: | 313-833-7593 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-01-29 |
Last Update Date: | 2015-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | AS820360989 | 320800000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |