Harris, Ivy
Harris, Ivy is an sole proprietor health care provider with primary practice located at 4613 Marthas Way , Grovetown GA 30813-2205. She recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as her primary health care specialty. Harris, Ivy can be contacted via phone (732) 962-5450.Contact Information
Primary practice address
4613 Marthas Way
Grovetown GA 30813-2205
Phone: (732) 962-5450
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320600000X |
Profile Details
| NPI number | 1073926812 |
|---|---|
| LBN Legal business name | Harris, Ivy |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 10th, 2014 |
| Last updated | Jun 10th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073926812 | NPPES |
| Georgia | MEDICAID | 000606317B |
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