MEDICARE: IVY L FAUNTROY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1861338493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY L FAUNTROY

Provider Business Mailing Address
First Line	:	2400 SOUTHERN AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1915
Country	:	US
Telephone Number	:	202-425-9488
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 5TH ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-5424
Country	:	US
Telephone Number	:	202-425-9488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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Directions to “ IVY L FAUNTROY ” Practice Location

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