Provider Demographics
NPI:1144799545
Name:IVY HEALTH CASE MANAGEMENT LLC
Entity Type:Organization
Organization Name:IVY HEALTH CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONTESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:678-524-1220
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-0904
Mailing Address - Country:US
Mailing Address - Phone:678-524-1220
Mailing Address - Fax:
Practice Address - Street 1:313 VININGS VINTAGE CIR
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7236
Practice Address - Country:US
Practice Address - Phone:678-524-1220
Practice Address - Fax:866-936-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty