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General NPI Number Information
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NPI Number | 1144799545
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Entity Type | Organization
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Legal Business Name | IVY HEALTH CASE MANAGEMENT LLC
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2453 POWDER SPRINGS RD SW STE 325A
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City | MARIETTA
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State | GA
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Zip | 30064-4570
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Country | US
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Telephone | 678-915-2633
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Fax | 678-915-1766
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Provider Business Mailing Address
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Address Line | PO BOX 904
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City | MABLETON
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State | GA
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Zip | 30126-0904
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Country | US
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Telephone | 678-524-1220
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CONTESSA STRADER
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Credential | MS
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Telephone | 678-524-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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