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General NPI Number Information
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NPI Number | 1922718774
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Entity Type | Organization
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Legal Business Name | PRUITTHEALTH HOME HEALTH, INC.
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 4250 LAKESIDE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3358
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Country | US
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Telephone | 833-679-5232
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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 | 678-296-0751
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPECIALIST
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Name | LYNETHIA NYTONYA HOLLEY
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Credential |
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Telephone | 786-296-0751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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