INTEGRATED LIFE CENTER INC. NPI 1427199199

NPI Information

NPI: 1427199199
Provider Name: INTEGRATED LIFE CENTER, INC.
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
4641 STONEGATE INDUSTRIAL BLVD
STONE MOUNTAIN, GA
ZIP 30083
Phone: (404) 377-5556
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INTEGRATED LIFE CENTER, INC. is a community based residential treatment facility mental illness in Stone Mountain, GA. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. INTEGRATED LIFE CENTER, INC. NPI is 1427199199. The provider is registered as an organization entity type.

The provider's business location address is:

4641 STONEGATE INDUSTRIAL BLVD
STONE MOUNTAIN, GA
ZIP 30083-908
Phone: (404) 377-5556
Fax: (404) 292-9903

The provider's authorized official is Dennis Arthur O'brien .
The authorized official title is Ceo and has the following contact phone number (404) 377-5556.

The enumeration date for this NPI number is 2/8/2007 and was last updated on 11/21/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		025893	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1427199199	MEDICARE OSCAR/CERTIFICATION	GEORGIA
2	00921324A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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