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General NPI Number Information
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NPI Number | 1699336776
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Entity Type | Organization
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Legal Business Name | IVY AT GASTONIA LLC
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 4414 WILKINSON BLVD
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City | GASTONIA
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State | NC
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Zip | 28056-8271
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Country | US
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Telephone | 305-912-9260
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Fax |
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Provider Business Mailing Address
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Address Line | 9429 HARDING AVE # 141
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City | SURFSIDE
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State | FL
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Zip | 33154-2803
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHAIM HYMAN
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Credential |
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Telephone | 305-912-9260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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