Moultrie I Enterprises, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MOULTRIE I ENTERPRISES, LLC

Doing business as

Park Regency of Moultrie

Practice address

3000 Veterans Pkwy S
Moultrie, GA 31788-7762

Phone

(229) 890-3342

Fax

(229) 891-3355

NPI assigned

Jun 18, 2010

Last updated

Jun 18, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Blake

Title

Managing Member

Phone

(817) 348-8841

Specialties & licenses 1

Addresses

Other names 1

• Park Regency of Moultrie Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276819200000",
    "number": "1881915338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 VETERANS PKWY S",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317887762",
            "telephone_number": "229-890-3342",
            "fax_number": "229-891-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 VETERANS PKWY S",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317887762",
            "telephone_number": "229-890-3342",
            "fax_number": "229-891-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE I ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2010-06-18",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8841"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Regency of Moultrie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nedra N Moore
• Stephen William Moore, DDS
• Anthony M Moser, MD
• Moultrie Center for Adult and Pediatric Healthcare, PC
• Moultrie Healthway, LLC
• Moultrie Internal Medicine Associates PC
• Moultrie Orthodontics, P.C.
• Moultrie Orthopedic Clinic, P.C.
• Moultrie Pediatrics, LLC (Children's Medical Group of SW GA)
• Moultrie Urological Clinic, Inc

• Assisted Living Facility in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.