Organization
IVY CREEK OF TALLAPOOSA, LLC
Active
Other names
STILLWATER'S FAMILY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D BRUCE CEO (CEO / OWNER)
(334) 567-4311
Entity
Organization
Contact information
Practice address
5958 HIGHWAY 49 S UNIT K, DADEVILLE, AL 36853-6771
(256) 825-7871
Mailing address
5958 HIGHWAY 49 S UNIT K, DADEVILLE, AL 36853-6771
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/06/2022
Last updated
10/06/2022
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