Healthcare Provider Details

I. General information

NPI: 1821744418
Provider Name (Legal Business Name): IVY WOODS CENTER FOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 MARKET ST
NORTH LIMA OH
44452-8564
US

IV. Provider business mailing address

50 CHESTNUT RIDGE RD STE 107
MONTVALE NJ
07645-1823
US

V. Phone/Fax

Practice location:
  • Phone: 330-549-3939
  • Fax:
Mailing address:
  • Phone: 908-327-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI WEISZ
Title or Position: CFO
Credential:
Phone: 347-631-4068