Organization
IVYCREEK OF ELMORE LLC
Active
Parent organization
IVYCREEK OF ELMORE LLC
Other names
ELMORE COMMUNITY HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVYCREEK OF ELMORE LLC
Authorized official
MICHAEL D BRUCE (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
500 HOSPITAL DR, WETUMPKA, AL 36092-1625
(334) 567-4311
(334) 567-4312
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 567-4311
(334) 567-4312
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
H2601
AL
146N00000X
Basic Emergency Medical Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D680545
CLIA
AL
05
—
529905190
—
AL
Enumeration date
07/10/2007
Last updated
04/05/2022
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