Provider Demographics
NPI:1568245447
Name:IVY RIDGE CARE INC
Entity Type:Organization
Organization Name:IVY RIDGE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAK
Authorized Official - Middle Name:KEUNG
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-813-8018
Mailing Address - Street 1:5050 LAGUNA BLVD
Mailing Address - Street 2:STE 112 #798
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4151
Mailing Address - Country:US
Mailing Address - Phone:916-813-8018
Mailing Address - Fax:
Practice Address - Street 1:2030 23RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1718
Practice Address - Country:US
Practice Address - Phone:916-813-8018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility