# IVY HALL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ivy Hall Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851362511
- **Authorized official:** JUDY CARVER DELOACH (PRESIDENT)
- **Authorized official phone:** (423) 542-6512

## Contact information

- **Practice address:** 301 S WATAUGA AVE, ELIZABETHTON, TN 37643-3546
- **Practice address phone:** (423) 542-6512
- **Practice address fax:** (423) 542-9311
- **Mailing address:** 301 S WATAUGA AVE, ELIZABETHTON, TN 37643-3546
- **Mailing address phone:** (423) 542-6512
- **Mailing address fax:** (423) 542-9311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 0000000025 | TN | — |
| 314000000X | Skilled Nursing Facility | 0000000025 | TN | Yes |

## Other

- **Enumeration date:** 01/31/2006
- **Last updated:** 09/05/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445469 | — | TN |
| 05 | — | 7440103 | — | TN |