Provider Demographics
NPI:1033642137
Name:INTEGRATED LIFE CHOICES, INC.
Entity Type:Organization
Organization Name:INTEGRATED LIFE CHOICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIDGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-742-0311
Mailing Address - Street 1:13627 POPLAR CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2219
Mailing Address - Country:US
Mailing Address - Phone:402-742-0311
Mailing Address - Fax:
Practice Address - Street 1:13627 POPLAR CIR STE 104
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2219
Practice Address - Country:US
Practice Address - Phone:402-742-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59388251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE95891857Medicaid
NE20792877Medicaid
NE93038983Medicaid
NE41596728Medicaid
NE51835644Medicaid