Organization
IVY HOME CARE LLC
Active
Other names
IVY HOME CARE
Organization subpart
No
Provider details
NPI number
Authorized official
DORINE NIKUZE (ADMINISTRATION)
(480) 300-1277
Entity
Organization
Contact information
Practice address
7506 S 45TH AVE, LAVEEN, AZ 85339-4296
(480) 300-1277
Mailing address
7506 S 45TH AVE, LAVEEN, AZ 85339-4296
(480) 300-1277
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH7845
—
AZ
Enumeration date
08/17/2022
Last updated
08/17/2022
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