Provider Demographics
NPI:1366765596
Name:IVORY HOMEHEALTH AGENCY INC
Entity type:Organization
Organization Name:IVORY HOMEHEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODHONG
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:972-803-5616
Mailing Address - Street 1:12000 FORD RD STE A411
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7249
Mailing Address - Country:US
Mailing Address - Phone:972-803-5616
Mailing Address - Fax:214-593-4341
Practice Address - Street 1:12000 FORD RD STE A411
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:972-803-5616
Practice Address - Fax:214-593-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013567251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health