| Organization Name: | IVYCREEK OF ELMORE LLC |
| NPI Number: | 1366565152 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL D BRUCE (CEO) |
| Mailing Address: | 41 Cambridge Ct Wetumpka |
| State: | AL US |
| Postal Code: | 360931261 |
| Phone Number: | 3345673309 |
| Fax Number: | 3345673361 |
| NPI Enumeration Date: | 04/09/2007 |
| NPI Last Update Date: | 10/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 305R00000X |
| License Number: | 22736 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Preferred Provider Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |