# BLACKSTONE MARY IVY HEALTHCARE LLC

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

## Provider details

- **NPI number:** 1982469540
- **Authorized official:** ATO K SMITH-MENSAH (ADMINISTRATOR)
- **Authorized official phone:** (571) 234-3699

## Contact information

- **Practice address:** 8951 BIRCH BAY CIR, LORTON, VA 22079-5660
- **Practice address phone:** (571) 234-3699
- **Mailing address:** 8951 BIRCH BAY CIR, LORTON, VA 22079-5660
- **Mailing address phone:** (571) 234-3699

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2024
- **Last updated:** 02/13/2024