Provider Demographics
NPI:1861899759
Name:IVY HOUSES
Entity type:Organization
Organization Name:IVY HOUSES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAI'JA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:202-431-3535
Mailing Address - Street 1:1701 PENNSYLVANIA AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-5805
Mailing Address - Country:US
Mailing Address - Phone:202-431-3535
Mailing Address - Fax:
Practice Address - Street 1:627 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2757
Practice Address - Country:US
Practice Address - Phone:202-431-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAMBS & IVY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
GA347C00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No347C00000XTransportation ServicesPrivate Vehicle