# IVYCREEK OF ELMORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IVYCREEK OF ELMORE LLC
- **Other names:** ELMORE COMMUNITY HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205034428
- **Legal business name:** IVYCREEK OF ELMORE LLC
- **Authorized official:** MICHAEL D BRUCE (CEO)
- **Authorized official phone:** (334) 567-4311

## Contact information

- **Practice address:** 500 HOSPITAL DR, WETUMPKA, AL 36092-1625
- **Practice address phone:** (334) 567-4311
- **Practice address fax:** (334) 567-4312
- **Mailing address:** PO BOX 130, WETUMPKA, AL 36092-0003
- **Mailing address phone:** (334) 567-4311
- **Mailing address fax:** (334) 567-4312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 146N00000X | Basic Emergency Medical Technician | H2601 | AL | — |
| 146N00000X | Basic Emergency Medical Technician | — | NULL | Yes |
| 146N00000X | Basic Emergency Medical Technician | — | — | Yes |

## Other

- **Enumeration date:** 07/10/2007
- **Last updated:** 04/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01D680545 | CLIA | AL |
| 05 | — | 529905190 | — | AL |