Provider Demographics
NPI:1588197065
Name:INTEGRATED LIFE CHOICES
Entity Type:Organization
Organization Name:INTEGRATED LIFE CHOICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY IMPROVEMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-742-0311
Mailing Address - Street 1:6800 NORMAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6828
Mailing Address - Country:US
Mailing Address - Phone:402-742-0311
Mailing Address - Fax:
Practice Address - Street 1:6800 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6828
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:2017-04-11
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE41596728Medicaid
NE51835644Medicaid
NE95891857Medicaid
NE93038983Medicaid
NE20792877Medicaid