Provider Demographics
NPI:1609829100
Name:IVY HOME INFUSIONS LLC
Entity Type:Organization
Organization Name:IVY HOME INFUSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIONET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-279-2425
Mailing Address - Street 1:2841 DE BARR RD
Mailing Address - Street 2:STE 20
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-279-2425
Mailing Address - Fax:907-279-2426
Practice Address - Street 1:2841 DE BARR RD
Practice Address - Street 2:STE 20
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-279-2425
Practice Address - Fax:907-279-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
AKPHAR4263336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996879OtherPK
AKPH7680Medicaid
0255970001Medicare NSC
AK160552Medicare UPIN