Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivy Lane Residence LLC

Organization Adult Care Home Facility · NPI 1679341770

Ivy Lane Residence LLC is an Adult Care Home Facility in Wyoming, Michigan. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4897 Grenadier Dr SW
Wyoming, MI 49509-5021
Phone: (612) 232-5643
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Care Home Facility (primary) Taxonomy 311ZA0620X

Record details

NPI number1679341770
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Najib Moalin — Director · (612) 232-5643
NPI enumeratedDecember 18, 2023
Last updated in NPPESDecember 18, 2023
Certification dateDecember 18, 2023
Mailing address4897 Grenadier Dr Sw, Wyoming, MI 49509-5021

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