Healthcare Provider Details

I. General information

NPI: 1245285253
Provider Name (Legal Business Name): PRUITTHEALTH - NEUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 HEALTH DR
NEW BERN NC
28560-4371
US

IV. Provider business mailing address

1626 JEURGENS CT
NORCROSS GA
30093-2219
US

V. Phone/Fax

Practice location:
  • Phone: 252-634-2560
  • Fax: 252-638-1485
Mailing address:
  • Phone: 770-279-6200
  • Fax: 770-931-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0496
License Number StateNC

VIII. Authorized Official

Name: MR. NEIL L PRUITT JR.
Title or Position: CHAIRMAN AND CEO OF MANAGER
Credential:
Phone: 770-279-6200