# IVY AT DEER LODGE LLC

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

## Provider details

- **NPI number:** 1356988349
- **Authorized official:** MR. RYAN MORRIS COANE (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (305) 912-9260

## Contact information

- **Practice address:** 1100 TEXAS AVE, DEER LODGE, MT 59722-1829
- **Practice address phone:** (406) 846-1655
- **Mailing address:** 9429 HARDING AVE \# 141, SURFSIDE, FL 33154-2803
- **Mailing address phone:** (305) 912-9260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |

## Other

- **Enumeration date:** 12/09/2019
- **Last updated:** 01/12/2021