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PRUITTHEALTH - BLUE RIDGE LLC NPI 1710010715


NPI Information

NPI: 1710010715
Provider Name: PRUITTHEALTH - BLUE RIDGE LLC

Doing Business As: PRUITTHEALTH COMMUNITY SERVICES - BLUE RIDGE

Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
74 OUIDA STREET
BLUE RIDGE, GA
ZIP 30513
Phone: (706) 258-2819
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PRUITTHEALTH - BLUE RIDGE LLC is an adult care home custodial care facility in Blue Ridge, GA. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. PRUITTHEALTH - BLUE RIDGE LLC NPI is 1710010715. The provider is registered as an organization entity type.
The provider Is Doing Business As Pruitthealth Community Services - Blue Ridge.

The provider's business location address is:

74 OUIDA STREET
BLUE RIDGE, GA
ZIP 30513
Phone: (706) 258-2819

The provider's authorized official is Neil L. Pruitt .
The authorized official title is Chairman And Ceo and has the following contact phone number (770) 279-6200.

The enumeration date for this NPI number is 3/13/2007 and was last updated on 6/30/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1311ZA0620XCustodial Care FacilityAdult Care HomeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100140973AMEDICAIDGEORGIA
2115468MEDICARE OSCAR/CERTIFICATIONGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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