Provider Demographics
NPI:1144935289
Name:INTEGRATIVE LIFE CENTER, CHATTANOOGA
Entity type:Organization
Organization Name:INTEGRATIVE LIFE CENTER, CHATTANOOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:KFOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-455-3303
Mailing Address - Street 1:1105 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7385 APPLEGATE LN
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5234
Practice Address - Country:US
Practice Address - Phone:423-561-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility