Organization
IVY CREEK OF TALLAPOOSA LLC
Active
Other names
LAKE MARTIN HOME HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM TIDWELL RN (HOME HEALTH DIRECTOR)
(256) 397-1440
Entity
Organization
Contact information
Practice address
301 MARIARDEN RD, SUITE F, DADEVILLE, AL 36853-6254
(256) 825-7050
(256) 825-7068
Mailing address
301 MARIARDEN RD, SUITE F, DADEVILLE, AL 36853-6254
(256) 825-7050
(256) 825-7068
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
017117
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAK7117A
—
AL
Enumeration date
12/07/2007
Last updated
04/05/2022
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