Organization
INTEGRATED LIFE CHOICES (ILC)
Active
Parent organization
INTEGRATED LIFE CHOICES (ILC)
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTEGRATED LIFE CHOICES (ILC)
Authorized official
RUSS HERNANDEZ (QUALITY IMPROVEMENT COORDINATOR)
(303) 484-8990
Entity
Organization
Contact information
Practice address
7222 COMMERCE CENTER DR STE 175, COLORADO SPRINGS, CO 80919-2226
(719) 465-1538
Mailing address
PO BOX 80728, LINCOLN, NE 68501-0728
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36358851
—
CO
Enumeration date
05/05/2021
Last updated
05/05/2021
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