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IVY CREEK OF ELMORE, LLC
NPI 1578060349
Clinic/Center - Rural Health in Deatsville, AL

Active since April 09, 2018
4412 HOGAN RD, DEATSVILLE, AL 36022(334) 514-4851(334) 543-4854 Get Directions Write a Review

NPPES record last updated: March 20, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 20, 2025, Apr 5, 2022, Apr 9, 2018 (3 updates tracked since 2018).

About Ivy Creek Of Elmore, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IVY CREEK OF ELMORE, LLC (NPI 1578060349), doing business as Ivy Creek Family Care Of Holtville, is a healthcare organization registered as a rural health in Deatsville, Alabama and active in the NPI registry since April 2018. The organization lists Jade Lane, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1578060349
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameIVY CREEK OF ELMORE, LLC
Location Address4412 HOGAN RDDeatsville, AL 36022-3400
Mailing AddressPo Box 130Wetumpka, AL 36092-0003 · (334) 514-4851 · Fax (334) 543-4854
Phone(334) 514-4851
Fax(334) 543-4854
Organization SubpartNo
Authorized OfficialJade LaneCredentialing Manager · (334) 567-4311
Enumeration DateApril 9, 2018
Last NPPES UpdateMarch 20, 20253 updates tracked since enumeration
NPPES CertifiedMarch 20, 2025
✔ NPI 1578060349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
4412 HOGAN RD, Deatsville, AL 36022
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Other Names 1

Doing Business AsIvy Creek Family Care Of Holtville

Other Identifiers 4

Other1608AL · Medicare B
Other01D2153925AL · Clia
Medicaid231138AL
Other13474AL · Medicare A

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMIE C MATHIS CPNP-PC
Nurse Practitioner (Pediatrics)
4412 HOGAN RD
DEATSVILLE, AL 36022
Elmore County (334) 543-4851
CHRISTINA ELIZABETH BRADY NURSE PRACTITIONER
Nurse Practitioner
4412 HOGAN RD
DEATSVILLE, AL 36022
Elmore County (334) 543-4851

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ivy Creek Of Elmore, LLC's NPI number?

The NPI number for Ivy Creek Of Elmore, LLC is 1578060349. It was assigned to this organization in the NPPES registry on April 9, 2018. The provider is doing business as Ivy Creek Family Care Of Holtville.

Where is Ivy Creek Of Elmore, LLC located?

Ivy Creek Of Elmore, LLC is located at 4412 Hogan Rd, Deatsville, AL 36022. The listed phone number is (334) 514-4851.

What is Ivy Creek Of Elmore, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

When was this NPI record last updated?

The NPPES record for Ivy Creek Of Elmore, LLC was last updated on March 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.