Provider Demographics
NPI:1720398472
Name:IVY HILL FOUNDATION, INC
Entity Type:Organization
Organization Name:IVY HILL FOUNDATION, INC
Other - Org Name:IVY HILL THERAPEUTIC EQUESTRIAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-822-2515
Mailing Address - Street 1:1811 MILL RD
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944
Mailing Address - Country:US
Mailing Address - Phone:215-822-2515
Mailing Address - Fax:
Practice Address - Street 1:1811 MILL RD
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944
Practice Address - Country:US
Practice Address - Phone:215-822-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
PAPT01865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty