Organization
IVY CREEK OF TALLAPOOSA LLC
Active
Parent organization
IVY CREEK OF TALLAPOOSA LLC
Other names
Lake Martin Community Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVY CREEK OF TALLAPOOSA LLC
Authorized official
MR. MICHAEL BRUCE (OWNER/CEO)
(256) 825-7821
Entity
Organization
Contact information
Practice address
201 MARIARDEN RD, DADEVILLE, AL 36853-6244
(256) 825-7821
Mailing address
201 MARIARDEN RD, DADEVILLE, AL 36853-6244
(256) 825-7821
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
H6202
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010144
BC/BS
AL
05
—
HOS0052H
—
AL
Enumeration date
08/05/2010
Last updated
08/21/2020
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