NPIMap

Organization Active NPI

Pruitthealth Hospice, Inc

Doing business as Pruitthealth Hospice - Valdosta

  • Community Based Hospice Care Agency
  • Valdosta, GA
National Provider Identifier
1063450666
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PRUITTHEALTH HOSPICE, INC
Doing business as
Pruitthealth Hospice - Valdosta
Practice address
407 Cowart Ave
Valdosta, GA 31602-2635
Phone
(229) 242-1187
Fax
(229) 242-0562
NPI assigned
Jun 3, 2006
Last updated
Sep 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Neil L Pruitt Jr.
Title
Chairman and Ceo
Phone
(770) 925-1143

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X

Addresses

Primary practice location

407 Cowart Ave
Valdosta, GA 31602-2635

Mailing address

1626 Jeurgens CT
Legal Dept
Norcross, GA 30093-2219
Phone (770) 279-6200

Other identifiers 1

IdentifierTypeStateIssuer
00849494AMedicaidGA

Other names 1

  • Pruitthealth Hospice - Valdosta Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050331000143 GA Part A Provider - Hospice 2264344217 Practice locations: Valdosta, GA
O20190702003113 GA Part B Supplier - Clinic/Group Practice 2264344217 Receives reassigned benefits from 45 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Watkinsville, GA; Augusta, GA; Valdosta, GA; Union City, GA; Swainsboro, GA; Savannah, GA; Rome, GA; Macon, GA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063450666. Details of each certification follow.

Hospice certification: CCN 111571

Legal name
PRUITTHEALTH HOSPICE INC
Doing business as
PRUITTHEALTH HOSPICE - VALDOSTA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 16, 1998
Last certification
May 9, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Oct 14, 1993 in GA
Enrollment address
407 Cowart Avenue
Valdosta, GA 31602-2635

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Pruitthealth Hospice-ValdostaCCN 111571 · All quality measures
Ownership
For-Profit
Certified
Dec 16, 1998
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2241917Pruitthealth Hospice- Valdosta407 Cowart Avenue, Valdosta, GA 31602Certificate of waiverNov 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pruitthealth Hospice Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
United Health Services Inc Organization, Norcross, GA For-profit 5% Or Greater Indirect Ownership Interest Jan 2, 2006 100%
Philip W. Small Individual Corporate DirectorDirector Sep 17, 2013
Pruitthealth Inc Organization, Norcross, GA For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2022
Operational/Managerial Control Jan 2, 2006
Lisa P Hamby Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Jan 2, 2006 31.65%
Neil Little Pruitt Individual Corporate OfficerChairman and Ceo Jan 1, 2005 100%
Corporate DirectorChairman and Ceo Jan 1, 2005 50%
OtherChain Home Office Admin, Authori Jan 1, 2005 100%
Jessica Calvit Individual W-2 Managing EmployeeRegional Financial Manager Jan 1, 2022
Neil L Pruitt Jr Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Jan 2, 2006 35.93%
Shaleta Shanell Preaster Individual W-2 Managing EmployeeFacility Administrator Jul 16, 2018 100%
Nancy W Pruitt Individual Corporate OfficerSecretary Jan 2, 2006
Uhs-Pruitt Holdings, Inc. Organization, Norcross, GA For-profit 5% Or Greater Indirect Ownership Interest Jan 2, 2006 100%
Thomas R Beddingfield Individual Corporate DirectorDirector Sep 17, 2013 50%
United Health Services of Georgia, Inc. Organization, Norcross, GA For-profit 5% Or Greater Direct Ownership Interest Jan 2, 2006 99%
J Paige Pruitt Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Jan 2, 2006 31.32%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 123

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Pruitthealth - Ashburn LLC

    dba PruittHealth - Ashburn

    • Skilled Nursing Facility
    • Ashburn, GA
    • NPI 1851347108

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Pruitthealth Inc, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Athens Heritage LLC

    dba PruittHealth - Athens Heritage

    • Skilled Nursing Facility
    • Athens, GA
    • NPI 1316993769

    J Paige Pruitt Trust, Lisa P Hamby Trust

    CMS ownership
  • Pruitthealth - Augusta Hills LLC

    dba PruittHealth - Augusta Hills

    • Skilled Nursing Facility
    • Augusta, GA
    • NPI 1235186974

    United Health Services Inc

    CMS ownership
  • Pruitthealth - Augusta, LLC

    dba PruittHealth - Augusta

    • Skilled Nursing Facility
    • Augusta, GA
    • NPI 1295908846

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Pruitthealth Inc, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Austell, LLC

    dba PruittHealth - Austell

    • Skilled Nursing Facility
    • Austell, GA
    • NPI 1386690642

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Pruitthealth Inc, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Bethany, LLC

    dba PruittHealth - Bethany

    • Skilled Nursing Facility
    • Millen, GA
    • NPI 1184924458

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Pruitthealth Inc, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Blue Ridge, LLC

    dba PruittHealth - Blue Ridge

    • Skilled Nursing Facility
    • Blue Ridge, GA
    • NPI 1730136599

    Neil L Pruitt Jr Trust, United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Brookhaven, LLC

    dba PruittHealth - Brookhaven

    • Skilled Nursing Facility
    • Atlanta, GA
    • NPI 1336196468

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Christian City, LLC

    dba Christian City Rehabilitation Center

    • Skilled Nursing Facility
    • Union City, GA
    • NPI 1720221328

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Covington LLC

    dba PruittHealth - Covington

    • Skilled Nursing Facility
    • Covington, GA
    • NPI 1457797177

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, Uhs-Pruitt Holdings, Inc., United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Creekside, LLC
    • Skilled Nursing Facility
    • Augusta, GA
    • NPI 1104536077

    United Health Services of Georgia, Inc.

    CMS ownership
  • Pruitthealth - Crestwood, LLC
    • Skilled Nursing Facility
    • Valdosta, GA
    • NPI 1063036200

    J Paige Pruitt Trust, Lisa P Hamby Trust, Neil L Pruitt Jr Trust, United Health Services Inc, United Health Services of Georgia, Inc.

    CMS ownership
View all 123

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1063450666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 JEURGENS CT",
            "address_2": "LEGAL DEPT",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300932219",
            "telephone_number": "770-279-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 COWART AVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022635",
            "telephone_number": "229-242-1187",
            "fax_number": "229-242-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH HOSPICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN AND CEO",
        "authorized_official_telephone_number": "770-925-1143",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00849494A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pruitthealth Hospice - Valdosta",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pruitthealth Hospice - Valdosta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.