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General NPI Number Information
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NPI Number | 1255533642
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Entity Type | Organization
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Legal Business Name | IVY CREEK HOME HEALTH OF ELMORE, LLC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 500 HOSPITAL DRIVE
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City | WETUMPKA
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State | AL
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Zip | 36092-1625
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Country | US
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Telephone | 334-567-7710
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Fax | 334-567-3227
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | WETUMPKA
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State | AL
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Zip | 36092-0003
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Country | US
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Telephone | 334-567-7710
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Fax | 334-567-3227
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. KATHRINE KAY BRYAN
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Credential | LPN
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Telephone | 334-567-7710
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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 | 11797
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License Number State | AL
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