Ivydale at Willow Lodge

NPI #1750766507 in Moultrie, Georgia

Provider Information

NPI Number: 1750766507
Entity Type: Organization
Organization Name: Ivydale at Willow Lodge
Primary Specialty: Assisted Living Facility
Enumeration Date: Jul 22, 2015
Last Updated: Jul 22, 2015

Practice Location

Address: 3120 S MAIN ST
City: Moultrie
State: Georgia
ZIP Code: 31768-6702
Phone: (229) 668-4721

Authorized Official

Name: MRS. GENI AKRIDGE
Title: ADMINISTRATOR
Phone: (229) 668-4721

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility	310400000X	Primary

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