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General NPI Number Information
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NPI Number | 1124161054
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Entity Type | Organization
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Legal Business Name | BUTLER - IVY CREEK HOME HEALTH, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 605 MEETING AVE
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City | GEORGIANA
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State | AL
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Zip | 36033
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Country | US
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Telephone | 334-376-2286
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Fax | 334-376-3661
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Provider Business Mailing Address
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Address Line | 605 MEETING AVE
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City | GEORGIANA
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State | AL
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Zip | 36033-4522
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Country | US
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Telephone | 334-376-2286
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Fax | 334-376-3661
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Authorized Official
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Title or Position | CEO & AO
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Name | MICHAEL D BRUCE
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Credential |
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Telephone | 334-567-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 11769
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License Number State | AL
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