MEDICARE: PRUITTHEALTH - CHRISTIAN CITY, 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
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720221328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRUITTHEALTH - CHRISTIAN CITY, 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	:	7300 LESTER ROAD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-2328
Country	:	US
Telephone Number	:	770-964-3301
Fax Number	:	770-964-7041

Authorized Official
Title or Position	:	CHAIRMAN AND CEO
Name	:	MR. NEIL L. PRUITT JR.
Credential	:
Telephone Number	:	770-279-6200

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	06/30/2014

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