Healthcare Provider Details

I. General information

NPI: 1023658192
Provider Name (Legal Business Name): INTEGRATED LIFE CHOICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 S UNIVERSITY BLVD STE 230
CENTENNIAL CO
80122-3163
US

IV. Provider business mailing address

PO BOX 80728
LINCOLN NE
68501-0728
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-7944
  • Fax: 303-221-4236
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN SOLOMON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 402-742-0311