| Organization Name: | IVYCREEK OF ELMORE LLC |
| NPI Number: | 1205034428 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES G FAULK (CEO) |
| Mailing Address: | 500 Hospital Dr Wetumpka |
| State: | AL US |
| Postal Code: | 360921625 |
| Phone Number: | 3345674311 |
| Fax Number: | 3345674312 |
| NPI Enumeration Date: | 07/10/2007 |
| NPI Last Update Date: | 01/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146N00000X |
| License Number: | H2601 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Basic |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards. |