Provider Demographics
NPI:1417794579
Name:THE IVY HEALTH AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:THE IVY HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:328-298-4118
Mailing Address - Street 1:1319 RICHMOND AVE UNIT 667603
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-0073
Mailing Address - Country:US
Mailing Address - Phone:328-298-4118
Mailing Address - Fax:
Practice Address - Street 1:3138 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6207
Practice Address - Country:US
Practice Address - Phone:832-829-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management