MEDICARE: IVY SENIOR ACTIVITY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1558114736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVY SENIOR ACTIVITY CENTER LLC

Provider Business Mailing Address
First Line	:	14248 BELLAIRE BLVD STE 107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-7536
Country	:	US
Telephone Number	:	832-770-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	14248 BELLAIRE BLVD STE 107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-7536
Country	:	US
Telephone Number	:	346-440-8380
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NHU JEN
Credential	:
Telephone Number	:	832-770-4343

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	06/05/2026

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