# IVY CREEK OF TALLAPOOSA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKE MARTIN COMMUNITY HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720273303
- **Authorized official:** MICHAEL D BRUCE (CEO)
- **Authorized official phone:** (334) 567-4311

## Contact information

- **Practice address:** 201 MARIARDEN RD, DADEVILLE, AL 36853-6244
- **Practice address phone:** (256) 825-7821
- **Practice address fax:** (256) 825-5899
- **Mailing address:** 201 MARIARDEN RD, DADEVILLE, AL 36853-6244
- **Mailing address phone:** (256) 825-7821
- **Mailing address fax:** (256) 825-5899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | J115 | AL | Yes |

## Other

- **Enumeration date:** 09/07/2007
- **Last updated:** 04/05/2022