IVYDALE WELLNESS CENTER LLC
NPI 1326653783
Community/Behavioral Health in Winder, GA
NPI Status: Active since September 12, 2020
Contact Information
361 RESOURCE PKWY
WINDER, GA
ZIP 30680
Phone: (770) 291-0419
- Organization
- Community/Behavioral Health
- CLIA Number: 11D2178274
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 01-29-2028
About IVYDALE WELLNESS CENTER LLC
This page provides the complete NPI Profile along with additional information for Ivydale Wellness Center Llc, a provider established in Winder, Georgia operating as a Community/behavioral Health. The healthcare provider is registered in the NPI registry with number 1326653783 assigned on September 2020. The practitioner's primary taxonomy code is 251S00000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Dr. Ablavi Adodo Agomessou Np (Pmhnp-c)
- NPI
- 1326653783
- Provider Name
- IVYDALE WELLNESS CENTER LLC
- Entity Type
- Organization
- Location Address
- 361 RESOURCE PKWY WINDER, GA 30680
- Location Phone
- (770) 291-0419
- Mailing Address
- 881 IVYDALE LN LAWRENCEVILLE, GA 30045
- Mailing Phone
- (404) 819-8701
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 09-12-2020
- Last Update Date
- 09-12-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Community/Behavioral Health
- Taxonomy Code
- 251S00000X
- Type
- Agencies
- Taxonomy Description
- A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | |
| 2 | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 11D2178274
- Facility Type
- Practitioner Other
- Certificate Effective Date
- January 30, 2026
- Certificate Expiration Date
- January 29, 2028
- Laboratory Director
- ABLAVI A. AGOMESSOU
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Ivydale Wellness Center Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1326653783, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 67 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
WINDER, GA 30680
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1326653783, enumerated as an "organization" on September 12, 2020.
The provider is located at 361 RESOURCE PKWY WINDER, GA 30680 and the phone number is (770) 291-0419.
Community/Behavioral Health with taxonomy code 251S00000X.
