Provider Demographics
NPI:1073553566
Name:PRUITTHEALTH HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PRUITTHEALTH HOME HEALTH, INC.
Other - Org Name:PRUITTHEALTH HOME HEALTH - MONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-279-6200
Mailing Address - Street 1:1626 JEURGENS CT
Mailing Address - Street 2:LEGAL DEPT
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2219
Mailing Address - Country:US
Mailing Address - Phone:770-279-6200
Mailing Address - Fax:770-931-5278
Practice Address - Street 1:500 GREAT OAKS DRIVE
Practice Address - Street 2:SUITE 11
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8228
Practice Address - Country:US
Practice Address - Phone:770-267-5237
Practice Address - Fax:770-510-1592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRUITTHEALTH HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-244-H251E00000X, 311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117118Medicare Oscar/Certification