Organization
IVY GARDENS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA BANKS (C.E.O.)
(409) 256-5435
Entity
Organization
Contact information
Practice address
500 FOREST VILLAGE CIR, LA MARQUE, TX 77568-1504
(409) 256-5435
Mailing address
500 FOREST VILLAGE CIR, LA MARQUE, TX 77568-1504
(409) 256-5435
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
03/21/2018
Last updated
03/21/2018
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