Provider Demographics
NPI:1760135529
Name:INTEGRATIVE NEUROLIFE CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATIVE NEUROLIFE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMISSIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:KFOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-891-2226
Mailing Address - Street 1:1104 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 16TH AVE S STE C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2305
Practice Address - Country:US
Practice Address - Phone:615-891-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)