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NPI Code Detail

MEDICARE: PRUITTHEALTH - RALEIGH, LLC

MEDICARE: PRUITTHEALTH - RALEIGH, 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
1314000000XSkilled Nursing FacilityNH0618NC

General Provider Information

NPI Number : 1720309933
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRUITTHEALTH - RALEIGH, LLC
Provider Business Mailing Address
First Line : 1626 JEURGENS COURT
Second Line : LEGAL DEPT
City : NORCROSS
State : GA
Zip : 30093-2219
Country : US
Telephone Number : 919-755-0226
Fax Number : 919-755-0313
Provider Business Practice Location Address
First Line : 2420 LAKE WHEELER RD
Second Line :
City : RALEIGH
State : NC
Zip : 27603-2614
Country : US
Telephone Number : 919-755-0226
Fax Number : 919-755-0313
Authorized Official
Title or Position : CHAIRMAN AND CEO
Name : NEIL L. PRUITT JR.
Credential :
Telephone Number : 919-755-0226
Provider Enumeration Date : 06/22/2010
Last Update Date : 09/30/2021

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Directions to “PRUITTHEALTH - RALEIGH, LLC ” Practice Location

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