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IVY LANE RESIDENCE LLC
NPI 1679341770
Custodial Care Facility - Adult Care Home in Wyoming, MI

Active since December 18, 2023
4897 GRENADIER DR SW, WYOMING, MI 49509(612) 232-5643 Get Directions Write a Review

NPPES record last updated: December 18, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Ivy Lane Residence Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IVY LANE RESIDENCE LLC (NPI 1679341770) is a healthcare organization registered as an adult care home in Wyoming, Michigan and active in the NPI registry since December 2023. The organization lists Najib Moalin, Director, as its authorized official.

NPPES Registry Identity

NPI1679341770
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameIVY LANE RESIDENCE LLC
Location Address4897 GRENADIER DR SWWyoming, MI 49509-5021
Mailing Address4897 Grenadier Dr SwWyoming, MI 49509-5021
Phone(612) 232-5643
Organization SubpartNo
Authorized OfficialNajib MoalinDirector · (612) 232-5643
Enumeration DateDecember 18, 2023
NPPES CertifiedDecember 18, 2023
✔ NPI 1679341770 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
4897 GRENADIER DR SW, Wyoming, MI 49509
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ivy Lane Residence LLC's NPI number?

The NPI number for Ivy Lane Residence LLC is 1679341770. It was assigned to this organization in the NPPES registry on December 18, 2023.

Where is Ivy Lane Residence LLC located?

Ivy Lane Residence LLC is located at 4897 Grenadier Dr SW, Wyoming, MI 49509. The listed phone number is (612) 232-5643.

What is Ivy Lane Residence LLC's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

When was this NPI record last updated?

The NPPES record for Ivy Lane Residence LLC was last updated on December 18, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.