11D0645917 CLIA NUMBER - PRUITTHEALTH - OLD CAPITOL FDBA THE HERITAGE OF OLD CAPITOL

Laboratory Demographics

CLIA Number: 11D0645917

Facility Name: PRUITTHEALTH - OLD CAPITOL FDBA THE HERITAGE OF OLD CAPITOL

Facility Address:
310 HIGHWAY #1 BYPASS
LOUISVILLE, GA
ZIP 30434
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Facility Phone Number: 478 625-9473

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1467409987

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name	Field Value
CLIA Number	11D0645917
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	PRUITTHEALTH - OLD CAPITOL FDBA THE HERITAGE OF OLD CAPITOL
Street	310 HIGHWAY #1 BYPASS
City	LOUISVILLE
State	GA
ZIP	30434
Phone	478 625-9473
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024