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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