Organization Name: | IVY CREEK OF BUTLER, LLC |
NPI Number: | 1477979672 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATTI COOK (ADMINISTRATOR) |
Mailing Address: | 138 Jones St Georgiana |
State: | AL US |
Postal Code: | 360334510 |
Phone Number: | 3343760071 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2014 |
NPI Last Update Date: | 03/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |