Provider Demographics
NPI:1235186750
Name:PRUITTHEALTH-SAVANNAH, LLC
Entity Type:Organization
Organization Name:PRUITTHEALTH-SAVANNAH, LLC
Other - Org Name:PRUITTHEALTH - SAVANNAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN AND CEO OF MANAGER
Authorized Official - Prefix:
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 COURT
Mailing Address - Street 2:
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:706-886-0542
Practice Address - Street 1:12825 WHITE BLUFF ROAD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2993
Practice Address - Country:US
Practice Address - Phone:912-927-9416
Practice Address - Fax:912-927-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10251652314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00238323AMedicaid
GA115339Medicare Oscar/Certification