Organization
INTEGRATED LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS ARTHUR O'BRIEN M.D. (CEO)
(404) 377-5556
Entity
Organization
Contact information
Practice address
4641 STONEGATE INDUSTRIAL BLVD, STONE MOUNTAIN, GA 30083-1908
(404) 377-5556
(404) 292-9903
Mailing address
4641 STONEGATE INDUSTRIAL BLVD, STONE MOUNTAIN, GA 30083-1908
(404) 377-5556
(404) 292-0093
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
025893
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00921324A
—
GA
Enumeration date
02/08/2007
Last updated
11/21/2011
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