Organization Name: | IVY CREEK OF ELMORE LLC |
NPI Number: | 1316246812 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MIKE BRUCE (CEO) |
Mailing Address: | 815 Jackson Trace Rd Wetumpka |
State: | AL US |
Postal Code: | 360921504 |
Phone Number: | 3345672882 |
Fax Number: | 3345673361 |
NPI Enumeration Date: | 03/23/2011 |
NPI Last Update Date: | 09/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |