MEDICARE: INTEGRATED LIFE CHOICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1720950728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED LIFE CHOICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 80728
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68501-0728
Country	:	US
Telephone Number	:	402-742-0311
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 TOPEKA WAY
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-3130
Country	:	US
Telephone Number	:	720-814-2877
Fax Number	:

Authorized Official
Title or Position	:	QI DIRECTOR
Name	:	CHRISTINA M HARTZELL
Credential	:
Telephone Number	:	402-742-0311

Provider Enumeration Date	:	09/19/2025
Last Update Date	:	09/19/2025

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