Provider Demographics
NPI:1679241020
Name:THE IVY FOUNDATION LLC
Entity type:Organization
Organization Name:THE IVY FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:MARQUEZ
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:816-401-4124
Mailing Address - Street 1:2040 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2146
Mailing Address - Country:US
Mailing Address - Phone:816-401-4124
Mailing Address - Fax:
Practice Address - Street 1:2040 BIRCH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2146
Practice Address - Country:US
Practice Address - Phone:816-401-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)