IVY CREEK OF TALLAPOOSA LLC


Address: 201 Mariarden Rd, Dadeville, AL 36853-6244
Phone: 2568257821

IVY CREEK OF TALLAPOOSA LLC (NPI# 1659685345) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1659685345
Entity Type Organization
Organization Name IVY CREEK OF TALLAPOOSA LLC
Other Organization Name LAKE MARTIN COMMUNITY HOSPITAL
Practice Address 201 Mariarden Rd
Dadeville
AL 36853-6244
Practice Telephone 2568257821
Mailing Telephone 2568257821
Enumeration Date 2010-08-05
Last Update Date 2020-08-21
Authorized Official Name MR. MICHAEL BRUCE (OWNER/CEO)
Authorized Official Telephone 2568257821
Is Organization Subpart Y
Parent Organization Name IVY CREEK OF TALLAPOOSA LLC

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 275N00000X Medicare Defined Swing Bed Unit H6202 AL Hospital Units

Other Provider Identifier

State Issuer Identifier Type Code
AL BC/BS 010144 01
AL HOS0052H 05

Other Provider/Organization Names

Other Name Type Code
Lake Martin Community Hospital Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1225211709 Ivy Creek of Tallapoosa LLC Home Health 301 Mariarden Rd, Suite F, Dadeville, AL 36853-6254 2007-12-07
1932130002 Ivy Creek of Tallapoosa LLC Clinic/Center 301 Mariarden Rd, Dadeville, AL 36853-0129 2006-07-06

Office Location

Street Address 201 MARIARDEN RD
City DADEVILLE
State AL
Zip Code 36853-6244

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255303921 Tallapoosa Ems, LLC Ambulance 201 Mariarden Rd, Dadeville, AL 36853-6244 2006-02-06
1750980819 Ivy Creek Specialty Care Emergency Medicine 201 Mariarden Rd, Dadeville, AL 36853-6244 2020-10-20
1922440833 Juan Carlos Latorre Pharmacist 201 Mariarden Rd, Dadeville, AL 36853-6244 2013-07-19
1376889063 Sabrina Colley Davis Nurse Practitioner 201 Mariarden Rd, Dadeville, AL 36853-6244 2012-12-27
1811169857 Ivy Creek of Tallapoosa Emergency Medical Technician, Basic 201 Mariarden Rd, Dadeville, AL 36853-6244 2008-03-31
1720273303 Ivy Creek of Tallapoosa General Acute Care Hospital 201 Mariarden Rd, Dadeville, AL 36853-6244 2007-09-07
1346305216 Lake Martin Hospice LLC. Hospice Care, Community Based 201 Mariarden Rd, Dadeville, AL 36853-6244 2006-12-22
1962509182 Ivy Creek Medical Equipment, LLC Durable Medical Equipment & Medical Supplies 201 Mariarden Rd, Dadeville, AL 36853-6244 2006-09-20
1598783904 Ivy Creek of Tallapoosa, LLC General Acute Care Hospital 201 Mariarden Rd, Dadeville, AL 36853-6244 2006-07-17

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1528378197 Ivy Creek Medical Equipment, LLC Durable Medical Equipment & Medical Supplies 201 Mariarden Road, Dadeville, AL 36853 2010-10-18
1912125535 Casey Turner Pharmacist 459 North Broadnax Street, Dadeville, AL 36853 2007-04-20
1053467100 Anthony Leon Nix Pharmacist 221 E South Street, Dadeville, AL 36853 2007-01-25
1407879083 Karen J Mockler Family Medicine 1034 South Tallassee Street, Dadeville, AL 36853 2006-07-25
1902947336 Frank Langley Pearson Pharmacist 221 E South Street, Dadeville, AL 36853 2007-02-09
1194871251 Pamela Bass Gam Pharmacist 221 E South Street, Dadeville, AL 36853 2007-01-25
1942266408 Sridhar Krishnamurti Audiologist 301 Mariarden Rd, Lake Martin Community Hospital, Dadeville, AL 36853 2006-04-25
1124298351 State of Alabama Public Health or Welfare 535 N Broadnax St, Dadeville, AL 36853-0100 2008-03-04
1164538203 Robert William Bartel General Practice 301 Mariarden Rd, Dadeville, AL 36853-0129 2006-08-22
1790717858 John Raymond Durant General Practice 301 Mariarden Rd, Ste D, Dadeville, AL 36853-0129 2006-07-07
Find all providers in zip 36853

Taxonomy Information

Taxonomy Code 275N00000X
Grouping Hospital Units
Classification Medicare Defined Swing Bed Unit

Taxonomy Definition

A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit.
Notes: Source: Code of Federal Regulations #42, Section 482.66.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1477835825 United Florala, Inc Medicare Defined Swing Bed Unit 24273 Fifth Avenue, Florala, AL 36442 2011-09-12
1750480406 Crenshaw County Health Care Authority Medicare Defined Swing Bed Unit 101 Hospital Cir, Luverne, AL 36049-7329 2006-09-21
1255959144 Fort Payne Hospital Corporation Medicare Defined Swing Bed Unit 200 Medical Center Dr Sw, Fort Payne, AL 35968-3458 2020-07-08
1114548930 Geneva County Healthcare Authority, Inc. Medicare Defined Swing Bed Unit 1200 W Maple Ave, Geneva, AL 36340-1642 2020-05-04
1962056143 Mizell Memorial Hospital Medicare Defined Swing Bed Unit 702 N Main St, Opp, AL 36467-1626 2019-07-26
1659868297 Floyd Cherokee Medical Center LLC Medicare Defined Swing Bed Unit 400 Northwood Dr, Centre, AL 35960-1023 2018-04-19
1801309711 The Health Care Authority of The City of Eufaula Medicare Defined Swing Bed Unit 820 W Washington St, Eufaula, AL 36027-1822 2017-11-14
1821511866 St. Vincent's St. Clair, LLC Medicare Defined Swing Bed Unit 7063 Veterans Pkwy, Pell City, AL 35125-5114 2017-07-21
1447772751 Tanner Medical Center Alabama Inc Medicare Defined Swing Bed Unit 1032 Main St South, Wedowee, AL 36278-5139 2017-07-10
1083157275 Qhg of Enterprise Inc Medicare Defined Swing Bed Unit 400 N Edwards St, Enterprise, AL 36330-2510 2016-11-21
Find all providers with the same taxonomy

Competitor

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City DADEVILLE
Zip Code 36853

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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