Organization
IVY LEAVES PLACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY NEWMAN (OWNER)
(817) 808-7172
Entity
Organization
Contact information
Practice address
7199 RENDON BLOODWORTH RD, MANSFIELD, TX 76063-4925
(817) 483-1294
Mailing address
7199 RENDON BLOODWORTH RD, MANSFIELD, TX 76063-4925
(817) 483-1294
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5646500178
—
TX
Enumeration date
12/02/2013
Last updated
12/02/2013
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