Provider Demographics
NPI:1770988123
Name:IVEYHOUSE LTD.
Entity type:Organization
Organization Name:IVEYHOUSE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LINDSTOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-382-3741
Mailing Address - Street 1:925 EDINBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2611
Mailing Address - Country:US
Mailing Address - Phone:804-835-9137
Mailing Address - Fax:804-835-9153
Practice Address - Street 1:2222 COLSTON ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2204
Practice Address - Country:US
Practice Address - Phone:804-835-9137
Practice Address - Fax:804-835-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002369320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities