Provider Demographics
NPI:1821329871
Name:IVYROSE LLC
Entity Type:Organization
Organization Name:IVYROSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PCA
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:POPILEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-969-6968
Mailing Address - Street 1:1219 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1217
Mailing Address - Country:US
Mailing Address - Phone:218-969-6968
Mailing Address - Fax:218-231-2082
Practice Address - Street 1:1219 13TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1217
Practice Address - Country:US
Practice Address - Phone:218-969-6968
Practice Address - Fax:218-231-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health