Healthcare Provider Details

I. General information

NPI: 1619854122
Provider Name (Legal Business Name): IVY ARBOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 HELVESTON ST
MOBILE AL
36617-3134
US

IV. Provider business mailing address

4827 OLD NATIONAL HWY # 11645
COLLEGE PARK GA
30337-6234
US

V. Phone/Fax

Practice location:
  • Phone: 251-202-9698
  • Fax:
Mailing address:
  • Phone: 251-202-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TAMI EDWARDS
Title or Position: CEO
Credential:
Phone: 251-202-9698