# PURE-IVY HEALTH CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134777667
- **Authorized official:** ADEWUNMI SOKAN (ADMINISTRATOR)
- **Authorized official phone:** (678) 789-2123

## Contact information

- **Practice address:** 1119 WESTGATE DR, LILBURN, GA 30047-3272
- **Practice address phone:** (678) 789-2123
- **Mailing address:** 1119 WESTGATE DR, LILBURN, GA 30047-3272
- **Mailing address phone:** (678) 789-2123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2019
- **Last updated:** 12/03/2024