Integrated Lifestyles LLC

NPI #1801121397 in Columbia, Missouri

Provider Information

NPI Number: 1801121397
Entity Type: Organization
Organization Name: Integrated Lifestyles LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Oct 16, 2009
Last Updated: Oct 16, 2009

Practice Location

Address: 820 BOURN AVE
City: Columbia
State: Missouri
ZIP Code: 65203-1459
Phone: (573) 445-4409

Authorized Official

Name: MR. JON GILLIOM
Title: ADMINISTRATOR
Phone: (573) 445-4409

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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