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General NPI Number Information
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NPI Number | 1770539082
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Entity Type | Organization
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Legal Business Name | PRUITTHEALTH - GREENVILLE LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 99 HILL HAVEN RD
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City | GREENVILLE
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State | GA
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Zip | 30222-3107
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Country | US
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Telephone | 706-672-4241
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 JEURGENS CT
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City | NORCROSS
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State | GA
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Zip | 30093-2219
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Country | US
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Telephone | 770-279-6200
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN AND CEO
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Name | NEIL L PRUITT JR.
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Credential |
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Telephone | 770-279-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1-099-1542
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License Number State | GA
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