Healthcare Provider Details

I. General information

NPI: 1467312264
Provider Name (Legal Business Name): INTEGRATED LIFE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 EMERALD WAY
FORESTDALE MA
02644-1529
US

IV. Provider business mailing address

PO BOX 283
FORESTDALE MA
02644-0283
US

V. Phone/Fax

Practice location:
  • Phone: 774-313-8445
  • Fax: 508-388-6195
Mailing address:
  • Phone: 774-313-8445
  • Fax: 508-388-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR DANIEL COBB
Title or Position: OWNER/FOUNDER
Credential: MPA, LSW, CDP, CGCM
Phone: 774-313-8445