Organization
IVY CREEK FAMILY CARE OF ENTERPRISE
Active
Other names
IVY CREEK FAMILY CARE OF ENTERPRISE
Organization subpart
No
Provider details
NPI number
Authorized official
JADE LANE (CREDENTIALING MANAGER)
(334) 567-4311
Entity
Organization
Contact information
Practice address
6582 BOLL WEEVIL CIR STE B, ENTERPRISE, AL 36330-9424
(334) 347-2027
(334) 347-2299
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 567-4311
(334) 512-0377
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/03/2025
Last updated
03/04/2025
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