Organization
MOULTRIE I ENTERPRISES, LLC
Active
Other names
Park Regency of Moultrie
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8841
Entity
Organization
Contact information
Practice address
3000 VETERANS PKWY S, MOULTRIE, GA 31788-7762
(229) 890-3342
(229) 891-3355
Mailing address
3000 VETERANS PKWY S, MOULTRIE, GA 31788-7762
(229) 890-3342
(229) 891-3355
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
06/18/2010
Last updated
06/18/2010
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