Healthcare Provider Details

I. General information

NPI: 1144799545
Provider Name (Legal Business Name): IVY HEALTH CASE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 POWDER SPRINGS RD SW STE 325A
MARIETTA GA
30064-4570
US

IV. Provider business mailing address

PO BOX 904
MABLETON GA
30126-0904
US

V. Phone/Fax

Practice location:
  • Phone: 678-915-2633
  • Fax: 678-915-1766
Mailing address:
  • Phone: 678-524-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CONTESSA STRADER
Title or Position: ADMINISTRATOR
Credential: MS
Phone: 678-524-1220