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General NPI Number Information
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NPI Number | 1255596359
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Entity Type | Organization
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Legal Business Name | IVY HOUSE ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 308 S STATE ST
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City | PAINESVILLE
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State | OH
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Zip | 44077-3532
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Country | US
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Telephone | 440-354-2131
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Fax | 440-354-2068
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Provider Business Mailing Address
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Address Line | 308 S STATE ST
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City | PAINESVILLE
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State | OH
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Zip | 44077-3532
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Country | US
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Telephone | 440-354-2131
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Fax | 440-354-2068
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MICHELLE M GIL
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Credential |
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Telephone | 440-354-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 0080R
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License Number State | OH
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