IVY CREEK OF ELMORE, LLC (NPI# 1578060349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578060349 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF ELMORE, LLC |
| Other Organization Name | IVY CREEK FAMILY CARE OF HOLTVILLE |
| Practice Address |
4412 Hogan Rd Deatsville AL 36022-3400 |
| Mailing Address |
Po Box 130 Wetumpka AL 36092-0003 |
| Practice Telephone | 3345144851 |
| Practice Fax Number | 3345434854 |
| Mailing Telephone | 3345144851 |
| Mailing Fax Number | 3345434854 |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2018-04-09 |
| Authorized Official Name | MICHAEL D BRUCE (CEO) |
| Authorized Official Telephone | 3345674311 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| IVY CREEK FAMILY CARE OF HOLTVILLE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619098977 | Ivy Creek of Elmore, LLC | Specialist | 201 S Washington Street., Autaugaville, AL 36003 | 2007-04-03 |
| 1508480633 | Ivy Creek of Elmore, LLC | Family Medicine | 525 Hospital Dr, Wetumpka, AL 36092-1626 | 2020-06-04 |
| 1558868323 | Ivy Creek of Elmore, LLC | Clinic/Center | 2256 Gilmer Ave, Tallassee, AL 36078-7114 | 2018-04-09 |
| 1669733895 | Ivy Creek of Elmore, LLC | Hospitalist | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2012-06-05 |
| 1720309982 | Ivy Creek of Elmore, LLC | Physical Medicine & Rehabilitation | 500 Hospital Dr, Suite A, Wetumpka, AL 36092-1625 | 2010-06-22 |
| 1154642684 | Ivy Creek of Elmore, LLC | Surgery | 500 Hospital Dr, Suite B, Wetumpka, AL 36092-1625 | 2010-06-18 |
| 1144547712 | Ivy Creek of Elmore, LLC | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-04-22 |
| 1255533642 | Ivy Creek of Elmore, LLC | Home Health | 500 Hospital Drive, Wetumpka, AL 36092-1625 | 2007-06-05 |
| 1093838880 | Ivy Creek of Elmore, LLC | Preferred Provider Organization | 74186 Tallassee Hwy, Wetumpka, AL 36092-5643 | 2007-04-09 |
| 1588795942 | Ivy Creek of Elmore, LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2007-03-08 |
| Street Address |
4412 HOGAN RD |
| City | DEATSVILLE |
| State | AL |
| Zip Code | 36022-3400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619352549 | Amanda Warr | Dietitian, Registered | 25 Skyline Dr, Deatsville, AL 36022 | 2015-07-21 |
| 1588862635 | Ti-resurrection Life Center, L.L.C. | Assisted Living Facility | 65 Charlton Place, Deatsville, AL 36022 | 2007-07-10 |
| 1437309317 | Deatsville Care Foundation, Inc. | Skilled Nursing Facility | 65 Charlton Place, 1240 County Road 39, Deatsville, AL 36022 | 2008-09-26 |
| 1972509453 | Resurrection Life Center | Skilled Nursing Facility | 1240 County Road 39, Deatsville, AL 36022-2536 | 2005-06-21 |
| 1871190256 | Charles M Thorn | Radiology | 204 Debbie Dr, Deatsville, AL 36022-2567 | 2020-10-08 |
| 1366725780 | Ashley Stone Sellers | Pharmacist | 174 Jasmine Ct, Deatsville, AL 36022-2588 | 2011-09-21 |
| 1184045957 | Brandy Stroup Young | Registered Nurse | 408 Hidden Valley Rd, Deatsville, AL 36022-2647 | 2013-12-21 |
| 1033351580 | Seana L Wade | Speech-Language Pathologist | 65 Charlton Pl, Deatsville, AL 36022-2697 | 2009-03-30 |
| 1922240472 | Robert Steven Browning | Registered Nurse | 65 Charlton Pl, Deatsville, AL 36022-2697 | 2009-03-30 |
| 1437653037 | Express Mro | Family Medicine | 2175 Us Highway 31 N, Deatsville, AL 36022-2714 | 2018-03-20 |
| Find all providers in zip 36022 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1205309044 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 184 William E Hill Drive Ste C, Carrollton, AL 35447 | 2019-01-04 |
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| 1205294428 | Red Bay Hospital Outpatient Clinics LLC | Clinic/Center | 14490 County Line Road, Suite A, Muscle Shoals, AL 35661 | 2016-02-02 |
| 1972985968 | Athens Limestone Pediatric Center LLC | Clinic/Center | 101 Fitness Way Ste 2100, Athens, AL 35611-2494 | 2015-06-25 |
| 1396125258 | D W Mcmillan Memorial Hospital | Clinic/Center | 1674 Cleveland Ave, Castleberry, AL 36432 | 2015-06-05 |
| 1982019402 | United Doctors Family Medical Center LLC | Clinic/Center | 235 Bent Brook Dr, Albertville, AL 35951-4107 | 2014-06-23 |
| Find all providers with the same taxonomy | ||||
| City | DEATSVILLE |
| Zip Code | 36022 |
Please comment or provide details below to improve the information on IVY CREEK OF ELMORE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.