NPI 1093838880

Ivy Creek of Elmore, LLC

Organisation Preferred Provider Organization Wetumpka, AL

Practice location

Address: 74186 Tallassee Hwy, Wetumpka, AL 36092-5643
Phone: (334) 567-0346
Fax: (334) 567-0855
Mailing address: 500 Hospital Dr, Wetumpka, AL 36092-1625

Authorised official

Name: Gordon Faulk
Title: Ceo
Phone: (334) 567-4311

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 00011939 (AL)

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Registry record

NPI: 1093838880
Entity type: Organization
NPI issued: 9 Apr 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.