NPIMap

Organization Active NPI

Ivy Hall, Inc

  • Skilled Nursing Facility
  • Elizabethton, TN
National Provider Identifier
1851362511
Registry record updated Sep 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0000000025 Issued in TN
Legal business name
IVY HALL, INC
Practice address
301 S Watauga Ave
Elizabethton, TN 37643-3546
Phone
(423) 542-6512
Fax
(423) 542-9311
NPI assigned
Jan 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2014

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

Authorized official

Name
Judy Carver Deloach
Title
President
Phone
(423) 542-6512

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 0000000025 TN
Skilled Nursing Facility 314000000X 0000000025 TN Primary

Addresses

Primary practice location

301 S Watauga Ave
Elizabethton, TN 37643-3546

Mailing address

301 S Watauga Ave
Elizabethton, TN 37643-3546
Phone (423) 542-6512

Other identifiers 2

IdentifierTypeStateIssuer
7440103MedicaidTN
0445469MedicaidTN

Other names 1

  • Ivy Hall Nursing Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20020822000008 TN Part A Provider - Skilled Nursing Facility 6901713932 Practice locations: Elizabethton, TN

Skilled nursing facility certification: CCN 445469

Legal name
IVY HALL INC
Doing business as
IVY HALL NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 2002
Last certification
Feb 16, 2022
Beds
101
Ownership / control type
Individual
Organization structure
CorporationProprietary
Incorporated
Jun 13, 1961 in TN
Enrollment address
301 South Watauga Ave
Elizabethton, TN 37643-3546
Nursing home name
IVY HALL NURSING HOME

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ivy Hall Nursing HomeCCN 445469
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Dec 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10184.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1002662Ivy Hall Nursing Home, Inc Dba301 Watauga Avenue, Elizabethton, TN 37643Certificate of waiverAug 12, 2026

National Provider Directory

National Provider Directory

Locations

301 S Watauga Ave
Elizabethton, TN 37643
Phone (423) 542-6512

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Judy C Deloach Individual 5% Or Greater Direct Ownership Interest Jun 8, 1971 100%
Corporate OfficerPresident Jun 8, 1971
Corporate DirectorSole Member Jun 8, 1971
W-2 Managing EmployeeFacility Administrator Jun 8, 1971
Operational/Managerial ControlPresident/Facility Aministrator Jun 8, 1971
Janelle M Carter Individual Corporate OfficerSecretary May 30, 1986
W-2 Managing EmployeeBusiness Office Manager May 30, 1986
Operational/Managerial ControlSecretary May 30, 1986
Care Centers Management Consulting, Inc. Organization, Johnson City, TN Corporation, Management services company, Consulting firm, For-profit Operational/Managerial Control Dec 18, 2006
Summer Fields Individual W-2 Managing EmployeeDirector of Nursing Apr 19, 2017
Operational/Managerial ControlDirector of Nursing Apr 19, 2017

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409875200000",
    "number": "1851362511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S WATAUGA AVE",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376433546",
            "telephone_number": "423-542-6512",
            "fax_number": "423-542-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S WATAUGA AVE",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376433546",
            "telephone_number": "423-542-6512",
            "fax_number": "423-542-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY HALL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2014-09-05",
        "status": "A",
        "authorized_official_last_name": "DELOACH",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "CARVER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-542-6512"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "0000000025",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440103",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445469",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivy Hall Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethton, TN

Sources for this page

Verify at the official NPI Registry.