Organization
INTEGRATED LIFE CHOICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN SOLOMON (DIRECTOR OF FINANCE)
(402) 742-0311
Entity
Organization
Contact information
Practice address
5630 N ACADEMY BLVD, COLORADO SPRINGS, CO 80918-3659
(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
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
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
01/07/2020
Last updated
01/07/2020
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