IVY CREEK OF ELMORE LLC NPI 1578060349

NPI Information

IVY CREEK OF ELMORE, LLC is a rural health clinic center in Deatsville, AL. IVY CREEK OF ELMORE, LLC NPI is 1578060349. The provider is registered as an organization entity type.
The provider Is Doing Business As Ivy Creek Family Care Of Holtville.

The provider's business location address is:

4412 HOGAN RD
DEATSVILLE, AL
ZIP 36022-400
Phone: (334) 514-4851
Fax: (334) 543-4854

The provider's authorized official is Michael D Bruce .
The authorized official title is Ceo and has the following contact phone number (334) 567-4311.

The CLIA number assigned to this NPI record is 01D2153925 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/9/2018 and was last updated on 4/9/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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