Ivy Terrace at Gambrill Gardens III

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

040294 Issued in MO

Legal business name

IVY TERRACE AT GAMBRILL GARDENS III

Practice address

1 Strecker Rd
Ellisville, MO 63011-1998

Phone

(636) 394-2992

NPI assigned

Mar 4, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Jane Harris, MSW, NHA

Title

Executive Director

Phone

(636) 394-2992

Specialties & licenses 1

Addresses

Other names 1

• Ivy Terrace Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1487995254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 STRECKER RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630111998",
            "telephone_number": "636-394-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 STRECKER RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630111998",
            "telephone_number": "636-394-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY TERRACE AT GAMBRILL GARDENS III",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "636-394-2992",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, NHA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "040294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivy Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joel T Hubbard, O.D.
• Shelby Hummel, DC
• Winter Renae Husband
• Elizabeth Huxel
• Lawrence Bruce Iken, DPM
• Jacqueline Hartman Inc
• Kerry Joe James, SA-C
• Jay F. Hauser, DDS, PC
• Musadiq Jeddy, RPH
• Jeremy M Frith DDS

• Assisted Living Facility in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.