Provider Demographics
NPI:1750329116
Name:PRUITTHEALTH HOSPICE, INC.
Entity Type:Organization
Organization Name:PRUITTHEALTH HOSPICE, INC.
Other - Org Name:PRUITTHEALTH HOSPICE - NEW BERN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CEO OF MGR
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:
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 1:810 KENNEDY AVENUE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560
Practice Address - Country:US
Practice Address - Phone:252-633-4311
Practice Address - Fax:252-633-3009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED HOSPICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS 3347315D00000X
NCHOS3347315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC341591Medicare Oscar/Certification