| Name: | BUTLER - IVY CREEK HOME HEALTH, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 31 Dec 2018 (6 years ago) |
| Entity Number: | 000-538-377 |
| Register Number: | 000538377 |
| Place of Formation: | Butler County |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124161054 | 2007-02-14 | 2021-05-11 | 425 S MEETING AVE, GEORGIANA, AL, 360334522, US | 435 MEETING AVE., GEORGIANA, AL, 36033, US | |||||||||||||||||||||||||
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| Phone | +1 334-376-2286 |
| Fax | 3343763661 |
Authorized person
| Name | MICHAEL D BRUCE |
| Role | CEO & AO |
| Phone | 3345674311 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 11769 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | REL7136A |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BRUCE, MIKE | Agent | 201 MARIARDEN RDDADEVILLE, AL 36853 |
| Name | Role | Address |
|---|---|---|
| BRUCE, MIKE | Organizer | 201 MARIARDEN RDDADEVILLE, AL 36853 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
