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Organization
IVY HALL, INC
Active
Organization
IVY HALL, INC
Active
Other names
Ivy Hall Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY CARVER DELOACH (PRESIDENT)
(423) 542-6512
Entity
Organization
Contact information
Practice address
301 S WATAUGA AVE, ELIZABETHTON, TN 37643-3546
(423) 542-6512
(423) 542-9311
Mailing address
301 S WATAUGA AVE, ELIZABETHTON, TN 37643-3546
(423) 542-6512
(423) 542-9311
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
0000000025
TN
314000000X
Skilled Nursing Facility
Primary
0000000025
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445469
—
TN
05
—
7440103
—
TN
Enumeration date
01/31/2006
Last updated
09/05/2014
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