1073553566 NPI number — PRUITTHEALTH HOME HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073553566 NPI number — PRUITTHEALTH HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRUITTHEALTH HOME HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073553566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1626 JEURGENS CT
Provider Second Line Business Mailing Address:
LEGAL DEPT
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30093-2219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-279-6200
Provider Business Mailing Address Fax Number:
770-931-5278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 GREAT OAKS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30655-8228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-267-5237
Provider Business Practice Location Address Fax Number:
770-510-1592
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRUITT
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CHAIRMAN & CEO
Authorized Official Telephone Number:
770-279-6200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  044-244-H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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