Provider Demographics
NPI:1043758048
Name:INTEGRATED LIFE CHOICES
Entity Type:Organization
Organization Name:INTEGRATED LIFE CHOICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-742-0311
Mailing Address - Street 1:PO BOX 80728
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68501-0728
Mailing Address - Country:US
Mailing Address - Phone:402-742-0311
Mailing Address - Fax:402-742-0312
Practice Address - Street 1:3110 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-4805
Practice Address - Country:US
Practice Address - Phone:303-484-8990
Practice Address - Fax:303-484-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36358851251C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty