Provider Demographics
NPI:1083597074
Name:IVEY HOUSE LLC
Entity type:Organization
Organization Name:IVEY HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:910-434-4763
Mailing Address - Street 1:4207 TRISTON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7547
Mailing Address - Country:US
Mailing Address - Phone:910-434-4763
Mailing Address - Fax:
Practice Address - Street 1:1417 MADISON ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2655
Practice Address - Country:US
Practice Address - Phone:910-434-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health