Provider Demographics
NPI:1922687284
Name:PRUITTHEALTH HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PRUITTHEALTH HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CORPORATE PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-533-6395
Mailing Address - Street 1:1626 JEURGENS COURT
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:
Practice Address - Street 1:9100 WHITE BLUFF ROAD
Practice Address - Street 2:STE 303
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3140
Practice Address - Country:US
Practice Address - Phone:770-279-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRUITTHEALTH HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health