NPIMap

Organization Active NPI

Ivy Creek Home Health of Elmore, LLC

Doing business as Ivy Creek Home Health of Elmore

  • Home Health Agency
  • Wetumpka, AL
National Provider Identifier
1255533642
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
11797 Issued in AL
Legal business name
IVY CREEK HOME HEALTH OF ELMORE, LLC
Doing business as
Ivy Creek Home Health of Elmore
Practice address
500 Hospital Drive
Wetumpka, AL 36092-1625
Phone
(334) 567-7710
Fax
(334) 567-3227
NPI assigned
Jun 5, 2007
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kathrine Kay Bryan, LPN
Title
Director
Phone
(334) 567-7710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 11797 AL Primary

Addresses

Primary practice location

500 Hospital Drive
Wetumpka, AL 36092-1625

Mailing address

PO Box 130
Wetumpka, AL 36092-0003
Phone (334) 567-7710

Other identifiers 1

IdentifierTypeStateIssuer
ELM7116AMedicaidAL

Other names 1

  • IVY CREEK HOME HEALTH OF ELMORE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051027001031 AL Part B Supplier - Clinic/Group Practice 8426075508 Receives reassigned benefits from 183 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deatsville, AL; Tallassee, AL; Wetumpka, AL
O20090303000702 AL Part A Provider - Home Health Agency 8426075508 Practice locations: Wetumpka, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255533642. Details of each certification follow.

Home health agency certification: CCN 017116

Legal name
IVY CREEK OF ELMORE LLC
Doing business as
IVY CREEK HOME HEALTH OF ELMORE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 26, 1993
Last certification
Jun 25, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Aug 29, 2000 in AL
Enrollment address
500 Hospital Dr
Wetumpka, AL 36092-1625
HHA Branch

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ivy Creek Home Health of ElmoreCCN 017116 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jul 26, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kathrine Bryan Individual W-2 Managing EmployeeDirector Nov 21, 2008
Michael David Bruce Individual 5% Or Greater Direct Ownership InterestCeo Mar 1, 2011 100%

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Elmore Community HospitalWetumpka, AL, CCN 010097 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2000
Wetumpka Family Rural Health ClinicWetumpka, AL, CCN 013960 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2000
Ivy Creek Family Care of HoltvilleDeatsville, AL, CCN 013474 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2018

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 20

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1255533642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360920003",
            "telephone_number": "334-567-7710",
            "fax_number": "334-567-3227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DRIVE",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360921625",
            "telephone_number": "334-567-7710",
            "fax_number": "334-567-3227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK HOME HEALTH OF ELMORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "KATHRINE",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "334-567-7710",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AL",
            "license": "11797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ELM7116A",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVY CREEK HOME HEALTH OF ELMORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wetumpka, AL

Sources for this page

Verify at the official NPI Registry.