| Organization Name: | IVY CREEK OF TALLAPOOSA LLC |
| NPI Number: | 1225211709 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAM TIDWELL (HOME HEALTH DIRECTOR) |
| Mailing Address: | 301 Mariarden Rd Suite F Dadeville |
| State: | AL US |
| Postal Code: | 368536254 |
| Phone Number: | 2568257050 |
| Fax Number: | 2568257068 |
| NPI Enumeration Date: | 12/07/2007 |
| NPI Last Update Date: | 01/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251E00000X |
| License Number: | 017117 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Home Health |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |