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IVYDALE AT WILLOW LODGE
NPI 1750766507
Assisted Living Facility in Moultrie, GA

Active since July 22, 2015CLIA 11D2103317 · Waiver
3120 S MAIN ST, MOULTRIE, GA 31768(229) 668-4721 Get Directions Write a Review

NPPES record last updated: July 22, 2015. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Ivydale At Willow Lodge NPPES

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

IVYDALE AT WILLOW LODGE (NPI 1750766507) is a healthcare organization registered as an assisted living facility in Moultrie, Georgia and active in the NPI registry since July 2015. The organization holds a CLIA Waiver certificate valid through October 8, 2027 and lists Geni Akridge, Administrator, as its authorized official.

NPPES Registry Identity

NPI1750766507
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameIVYDALE AT WILLOW LODGE
Location Address3120 S MAIN STMoultrie, GA 31768-6702
Mailing Address3120 S Main StMoultrie, GA 31768-6702 · (229) 668-4721
Phone(229) 668-4721
Organization SubpartNo
Authorized OfficialGeni AkridgeAdministrator · (229) 668-4721
Enumeration DateJuly 22, 2015
✔ NPI 1750766507 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in GA · PCH008684
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
3120 S MAIN ST, Moultrie, GA 31768
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2103317

Ivydale At Willow Lodge LLC · Moultrie, GA
Active · expires Oct 8, 2027
CLIA Number11D2103317
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 9, 2025
Certificate Expiration DateOctober 8, 2027
Laboratory DirectorGeni Akridge
Laboratory Phone(229) 668-4721
Laboratory LocationIvydale At Willow Lodge LLC3120 S Main St, Moultrie, GA 31768
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Ivydale At Willow Lodge's NPI number?

The NPI number for Ivydale At Willow Lodge is 1750766507. It was assigned to this organization in the NPPES registry on July 22, 2015.

Where is Ivydale At Willow Lodge located?

Ivydale At Willow Lodge is located at 3120 S Main St, Moultrie, GA 31768. The listed phone number is (229) 668-4721.

What is Ivydale At Willow Lodge's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Ivydale At Willow Lodge hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2103317) is associated with this NPI, valid through October 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ivydale At Willow Lodge was last updated on July 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years 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.