Healthcare Provider Details

I. General information

NPI: 1124161054
Provider Name (Legal Business Name): BUTLER - IVY CREEK HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/15/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MEETING AVE
GEORGIANA AL
36033
US

IV. Provider business mailing address

605 MEETING AVE
GEORGIANA AL
36033-4522
US

V. Phone/Fax

Practice location:
  • Phone: 334-376-2286
  • Fax: 334-376-3661
Mailing address:
  • Phone: 334-376-2286
  • Fax: 334-376-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11769
License Number StateAL

VIII. Authorized Official

Name: MICHAEL D BRUCE
Title or Position: CEO & AO
Credential:
Phone: 334-567-4311