Provider Demographics
NPI:1871156539
Name:IVY CREEK-BUTLER HOME HEALTH LLC
Entity type:Organization
Organization Name:IVY CREEK-BUTLER HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:334-567-4311
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:GEORGIANA
Mailing Address - State:AL
Mailing Address - Zip Code:36033-0548
Mailing Address - Country:US
Mailing Address - Phone:334-376-2286
Mailing Address - Fax:334-376-3661
Practice Address - Street 1:435 S.MEETING AVE
Practice Address - Street 2:
Practice Address - City:GEORGIANA
Practice Address - State:AL
Practice Address - Zip Code:36033-3603
Practice Address - Country:US
Practice Address - Phone:334-376-2286
Practice Address - Fax:334-376-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health