| Organization Name: | IVY CREEK OF TALLAPOOSA |
| NPI Number: | 1720273303 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AGNES WAGES (ADMINISTRATOR) |
| Mailing Address: | 201 Mariarden Rd Dadeville |
| State: | AL US |
| Postal Code: | 368536244 |
| Phone Number: | 2568257821 |
| Fax Number: | 2568255899 |
| NPI Enumeration Date: | 09/07/2007 |
| NPI Last Update Date: | 09/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NR1301X |
| License Number: | J115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Rural |
| Taxonomy Definition: | |