| Organization Name: | INTEGRATED LIFE CENTER, INC. |
| NPI Number: | 1427199199 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS ARTHUR O'BRIEN (CEO) |
| Mailing Address: | 4641 Stonegate Industrial Blvd Stone Mountain |
| State: | GA US |
| Postal Code: | 300831908 |
| Phone Number: | 4043775556 |
| Fax Number: | 4042929903 |
| NPI Enumeration Date: | 02/08/2007 |
| NPI Last Update Date: | 11/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | 025893 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |