=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558018648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED FUNCTIONAL SUPPORTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2022
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 E. CHICAGO RD
-----------------------------------------------------
City | COLDWATER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49036-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-462-1566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 PILLSBURY AVE
-----------------------------------------------------
City | COLDWATER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49036-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-462-1566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. LYNDSAY R WILLIAMS
-----------------------------------------------------
Credential | M.A., BCBA, LBA
-----------------------------------------------------
Telephone | 517-462-1566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------