| Ivy Creek Prevention Center Llc | |
|
2129 Moonbrook Dr Dadeville AL 36853-5640 | |
| (334) 514-3848 | |
| (334) 514-3686 |
| Full Name | Ivy Creek Prevention Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 2129 Moonbrook Dr, Dadeville, Alabama |
| Authorized Official Name and Position | Michael D Bruce (CEO) |
| Authorized Official Contact | 2566750412 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Prevention Center Llc Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 514-3848 | Ivy Creek Prevention Center Llc 2129 Moonbrook Dr Dadeville AL 36853-5640 Ph: (334) 514-3848 |
| NPI Number | 1659755577 |
|---|---|
| Provider Enumeration Date | 07/10/2015 |
| Last Update Date | 05/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659755577 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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