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NPI Code Detail

MEDICARE: PRUITTHEALTH - RALEIGH, LLC

MEDICARE: PRUITTHEALTH - RALEIGH, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH0618NC

General Provider Information

NPI Number : 1730136250
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRUITTHEALTH - RALEIGH, LLC
Provider Business Mailing Address
First Line : 1626 JEURGENS CT
Second Line :
City : NORCROSS
State : GA
Zip : 30093-2219
Country : US
Telephone Number : 770-279-6200
Fax Number :
Provider Business Practice Location Address
First Line : 2420 LAKE WHEELER RD
Second Line :
City : RALEIGH
State : NC
Zip : 27603-2614
Country : US
Telephone Number : 919-755-0226
Fax Number :
Authorized Official
Title or Position : CHAIRMAN AND CEO OF MANAGER
Name : NEIL L PRUITT JR.
Credential :
Telephone Number : 770-279-6200
Provider Enumeration Date : 05/29/2006
Last Update Date : 07/02/2014

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Directions to “PRUITTHEALTH - RALEIGH, LLC ” Practice Location

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