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IVY LANE RESIDENCE LLC NPI 1679341770


NPI Information

NPI: 1679341770
Provider Name: IVY LANE RESIDENCE LLC
Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
4897 GRENADIER DR SW
WYOMING, MI
ZIP 49509
Phone: (612) 232-5643
Get Directions

IVY LANE RESIDENCE LLC is an adult care home custodial care facility in Wyoming, MI. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. IVY LANE RESIDENCE LLC NPI is 1679341770. The provider is registered as an organization entity type.

The provider's business location address is:

4897 GRENADIER DR SW
WYOMING, MI
ZIP 49509-021
Phone: (612) 232-5643

The provider's authorized official is Najib Moalin .
The authorized official title is Director and has the following contact phone number (612) 232-5643.

The enumeration date for this NPI number is 12/18/2023 and was last updated on 12/18/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1311ZA0620XCustodial Care FacilityAdult Care HomeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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