IVEYHOUSE LTD. (NPI# 1770988123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770988123 |
| Entity Type | Organization |
| Organization Name | IVEYHOUSE LTD. |
| Practice Address |
2222 Colston St Petersburg VA 23805-2204 |
| Mailing Address |
925 Edinborough Dr Colonial Heights VA 23834-2611 |
| Practice Telephone | 8048359137 |
| Practice Fax Number | 8048359153 |
| Mailing Telephone | 8048359137 |
| Mailing Fax Number | 8048359153 |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |
| Authorized Official Name | JEFFREY EDWARD LINDSTOM (CEO) |
| Authorized Official Telephone | 8043823741 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 0002369 | VA | Residential Treatment Facilities |
| Street Address |
2222 COLSTON ST |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-2204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790340354 | Fobbs Family Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1618 Montpelier St, Petersburg, VA 23805-1329 | 2019-05-08 |
| 1306377114 | Harmony Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1586 Montpelier St, Petersburg, VA 23805-1331 | 2017-03-23 |
| 1679939169 | T'lab, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 823 S Jones St, Petersburg, VA 23803-4952 | 2016-01-13 |
| 1982026704 | Helping Hands of Virginia, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1604 Pine View Cir, Petersburg, VA 23803-4850 | 2014-01-14 |
| 1093141517 | Heart To Heart Residential Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2115 N Whitehill Dr, Petersburg, VA 23803-3731 | 2013-09-16 |
| 1255677845 | Taylors Enhanced Living IIi Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3267 S Crater Rd, Petersburg, VA 23805-9216 | 2012-12-31 |
| 1548580400 | A Dab of Hope, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 22906 Pheasant Ct, Petersburg, VA 23803-8411 | 2010-06-02 |
| 1194042515 | Damon Peterson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 24812 Brickwood Meadow Ln, Petersburg, VA 23803-8869 | 2010-04-24 |
| 1134374622 | Empty Arms Outreach Ministry, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4526 Brickwood Meadow Ct, Petersburg, VA 23803-8866 | 2008-11-25 |
| 1982677027 | Halo, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1857a Fort Mahone St, Petersburg, VA 23805-2761 | 2006-02-09 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.