# 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:** 1811169857
- **Authorized official:** MRS. CAROLINE MORRIS (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (256) 825-7821

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 146N00000X | Basic Emergency Medical Technician | 0712 | AL | Yes |

## Other

- **Enumeration date:** 03/31/2008
- **Last updated:** 04/05/2022