MEDICARE: INTEGRATED LIFE CHOICES

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1588197065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED LIFE CHOICES

Provider Business Mailing Address
First Line	:	6800 NORMAL BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-6828
Country	:	US
Telephone Number	:	402-742-0311
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 NORMAL BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-6828
Country	:	US
Telephone Number	:	402-742-0311
Fax Number	:

Authorized Official
Title or Position	:	QUALITY IMPROVEMENT COORDINATOR
Name	:	MRS. CHRISTINA HARTZELL
Credential	:
Telephone Number	:	402-742-0311

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	01/07/2020