Provider Demographics
NPI:1760869770
Name:INTEGRALIFE HEALTH & TRAUMA INSTITUTE, LLC
Entity Type:Organization
Organization Name:INTEGRALIFE HEALTH & TRAUMA INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKORO RELLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-221-3460
Mailing Address - Street 1:12730 HEACOCK ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3070
Mailing Address - Country:US
Mailing Address - Phone:951-221-3460
Mailing Address - Fax:951-924-0250
Practice Address - Street 1:12730 HEACOCK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3070
Practice Address - Country:US
Practice Address - Phone:951-221-3460
Practice Address - Fax:951-924-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency