| Organization Name: | IVY CREEK OF TALLAPOOSA LLC |
| NPI Number: | 1346305216 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONNIE J DENNIS (CLINICAL DIRECTOR) |
| Mailing Address: | 201 Mariarden Rd Dadeville |
| State: | AL US |
| Postal Code: | 368536244 |
| Phone Number: | 2568253272 |
| Fax Number: | 2568258578 |
| NPI Enumeration Date: | 12/22/2006 |
| NPI Last Update Date: | 04/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |