Organization
IVY LANE RESIDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAJIB MOALIN (DIRECTOR)
(612) 232-5643
Entity
Organization
Contact information
Practice address
4897 GRENADIER DR SW, WYOMING, MI 49509-5021
(612) 232-5643
Mailing address
4897 GRENADIER DR SW, WYOMING, MI 49509-5021
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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