Healthcare Provider Details

I. General information

NPI: 1558018648
Provider Name (Legal Business Name): INTEGRATED FUNCTIONAL SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E. CHICAGO RD
COLDWATER MI
49036-4903
US

IV. Provider business mailing address

102 PILLSBURY AVE
COLDWATER MI
49036-1564
US

V. Phone/Fax

Practice location:
  • Phone: 517-462-1566
  • Fax:
Mailing address:
  • Phone: 517-462-1566
  • 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 Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNDSAY R WILLIAMS
Title or Position: OWNER
Credential: M.A., BCBA, LBA
Phone: 517-462-1566