Healthcare Provider Details

I. General information

NPI: 1043758048
Provider Name (Legal Business Name): INTEGRATED LIFE CHOICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 S WADSWORTH BLVD SUITE 305
DENVER CO
80227-4805
US

IV. Provider business mailing address

PO BOX 80728
LINCOLN NE
68501-0728
US

V. Phone/Fax

Practice location:
  • Phone: 303-484-8990
  • Fax: 303-484-8676
Mailing address:
  • Phone: 402-742-0311
  • Fax: 402-742-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number36358851
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number36358851
License Number StateCO

VIII. Authorized Official

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