| Entity Name: | IVY BEHAVIORAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 22 Jan 2018 (7 years ago) |
| Document Number: | P18000007461 |
| FEI/EIN Number | 82-4145364 |
| Address: | 1437 N. Denver Ave. #157, Loveland, CO 80538 |
| Mail Address: | 2336 SE OCEAN BLVD, #167, STUART, FL 34996 |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | IVY BEHAVIORAL GROUP, INC., COLORADO | 20201687501 | COLORADO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851890628 | 2018-02-07 | 2021-05-06 | 1437 DENVER AVE # 157, LOVELAND, CO, 805385226, US | 2336 SE OCEAN BLVD # 167, STUART, FL, 349963310, US | |||||||||||||||||||||||||||||
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| Phone | +1 772-208-0071 |
| Fax | 7722139558 |
Authorized person
| Name | EMILY GOSSER IVY |
| Role | CEO/OWNER |
| Phone | 7722080071 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 1-12-11892 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 023921300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WAUTERS, JAMES J | Agent | 5422 NW CROMEY STREET, PORT SAINT LUCIE, FL 34986 |
| Name | Role | Address |
|---|---|---|
| IVY, TAYLOR N | Chief Financial Officer | 2154 NE Chestnut Ct, Jensen Beach, FL 34957 |
| Name | Role | Address |
|---|---|---|
| IVY, EMILY G | Chief Executive Officer | 2154 NE Chestnut Ct., Jensen Beach, FL 34957 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-28 | 1437 N. Denver Ave. #157, Loveland, CO 80538 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-10 | 1437 N. Denver Ave. #157, Loveland, CO 80538 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-03-12 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-09-09 |
| Domestic Profit | 2018-01-22 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
