| Name: | Ivy Creek Specialty Care LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Sep 2020 (4 years ago) |
| Entity Number: | 000-648-830 |
| Register Number: | 000648830 |
| County: | Elmore |
| Place of Formation: | Elmore County |
| Registered Office Street Address: | 500 Hospital DriveWetumpka, AL 36092 |
| Registered Office Street Address ZIP Code: | 36092 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750980819 | 2020-10-20 | 2020-10-20 | 201 MARIARDEN RD, DADEVILLE, AL, 368536244, US | 201 MARIARDEN RD, DADEVILLE, AL, 368536244, US | |||||||||||||
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| Phone | +1 256-825-7821 |
Authorized person
| Name | TERESA H LANGFORD |
| Role | CREDENTIALING MANAGER |
| Phone | 3342832542 |
Taxonomy
| Taxonomy Code | 207PE0004X - Emergency Medical Services (Emergency Medicine) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| IVY CREEK HEALTHCARE LLC | Agent | 16020 SW 80TH AVENUEMIAMI, FL 33157 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
