NPIMap

Organization Active NPI

Integrated Life Choices

  • Developmentally Disabled Services Day Training Agency
  • Elizabeth, CO
National Provider Identifier
1558868653
Registry record updated Oct 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
36358851 Issued in CO
Legal business name
INTEGRATED LIFE CHOICES
Practice address
240 Elizabeth St Ste H2
Elizabeth, CO 80107-7546
Phone
(303) 646-4402
Fax
(303) 646-4403
NPI assigned
Apr 6, 2018
Last updated
Oct 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Justin SolomonNPI 1275071268
Title
Director of Finance
Phone
(402) 742-0311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 36358851 CO Primary
Non-emergency Medical Transport (VAN) 343900000X 36358851 CO
Day Training/Habilitation Specialist 373H00000X 36358851 CO
Homemaker 376J00000X 36358851 CO
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X 36358851 CO

Addresses

Primary practice location

240 Elizabeth St Ste H2
Elizabeth, CO 80107-7546

Mailing address

PO Box 80728
Lincoln, NE 68501-0728
Phone (402) 742-0311

Other identifiers 1

IdentifierTypeStateIssuer
36358851MedicaidCO

Other names 1

  • Integrated Life Choices of Colorado Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Integrated Life Choices of Colorado5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

240 S Elizabeth St
Ste H2
Elizabeth, CO 80107
Phone (303) 646-4402

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540771200000",
    "number": "1558868653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80728",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685010728",
            "telephone_number": "402-742-0311",
            "fax_number": "402-742-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 ELIZABETH ST STE H2",
            "city": "ELIZABETH",
            "state": "CO",
            "postal_code": "801077546",
            "telephone_number": "303-646-4402",
            "fax_number": "303-646-4403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED LIFE CHOICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-06",
        "last_updated": "2018-10-29",
        "status": "A",
        "authorized_official_last_name": "SOLOMON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "402-742-0311"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "CO",
            "license": "36358851",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "CO",
            "license": "36358851",
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "CO",
            "license": "36358851",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "CO",
            "license": "36358851",
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "CO",
            "license": "36358851",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36358851",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Life Choices of Colorado",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Elizabeth, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.