Organization Name: | IVY CREEK OF TALLAPOOSA, LLC |
NPI Number: | 1598783904 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AGNES C WAGES (ADMINISTRATOR) |
Mailing Address: | 201 Mariarden Rd Dadeville |
State: | AL US |
Postal Code: | 368536244 |
Phone Number: | 2568257821 |
Fax Number: | 2568255899 |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 282NR1301X |
License Number: | 11872 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Hospitals |
Taxonomy Classification: | General Acute Care Hospital |
Taxonomy Specialization: | Rural |
Taxonomy Definition: |