Healthcare Provider Details

I. General information

NPI: 1952878209
Provider Name (Legal Business Name): R.E. PRUITT ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25000 EUCLID AVE STE 101
EUCLID OH
44117-2621
US

IV. Provider business mailing address

25000 EUCLID AVE STE 101
CLEVELAND OH
44117-2621
US

V. Phone/Fax

Practice location:
  • Phone: 216-744-9492
  • Fax:
Mailing address:
  • Phone: 216-744-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EUNETTA BRIMAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-744-9492