Provider Demographics
NPI:1467165258
Name:IVY STONE COMMUNITY LIVING LLC
Entity Type:Organization
Organization Name:IVY STONE COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMENKRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-488-5557
Mailing Address - Street 1:7999 N ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1402
Mailing Address - Country:US
Mailing Address - Phone:185-648-8555
Mailing Address - Fax:
Practice Address - Street 1:7999 N ROUTE 130
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1402
Practice Address - Country:US
Practice Address - Phone:185-648-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility