Organization Active NPI

Pruitthealth - Bamberg, LLC

Doing business as PruittHealth - Bamberg

  • Skilled Nursing Facility
  • Bamberg, SC
National Provider Identifier
1104063718
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PRUITTHEALTH - BAMBERG, LLC
Doing business as
PruittHealth - Bamberg
Practice address
439 North St
Bamberg, SC 29003-1330
Phone
(803) 245-7525
Fax
(803) 245-6747
NPI assigned
Jan 20, 2009
Last updated
Jun 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

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

Authorized official

Name
Mr. Neil L. Pruitt Jr.
Title
Chairman and Ceo
Phone
(770) 279-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

439 North St
Bamberg, SC 29003-1330

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
108093MedicaidSC

Other names 1

  • PruittHealth - Bamberg Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091016000131 SC Part A Provider - Skilled Nursing Facility 7113064510 Practice locations: Bamberg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104063718. Details of each certification follow.

Skilled nursing facility certification: CCN 425104

Legal name
PRUITTHEALTH - BAMBERG, LLC
Doing business as
PRUITTHEALTH - BAMBERG
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 15, 1976
Last certification
May 8, 2025
Beds
88
Ownership / control type
Individual
Multi-facility organization
Pruitt Health
Organization structure
LLCProprietary
Incorporated
Oct 22, 2008 in SC
Enrollment address
439 North Street
Bamberg, SC 29003-1330
Nursing home name
PRUITTHEALTH- BAMBERG
Affiliated entity
PRUITTHEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
PruittHealth- BambergCCN 425104 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Mar 15, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8882.5 residents per day on average
Chain
Pruitthealth95 facilities in the chain
Penalties (3 years)
4Fines totaling $34,606

Processed by Care Compare on Aug 1, 2026.

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
42D1104539Pruitthealth - Bamberg, LLC439 North Street, Bamberg, SC 29003Certificate of waiverSep 3, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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 Oct 22, 2008 99%
Pruitthealth Inc Organization, Toccoa, GA Corporation, For-profit Operational/Managerial Control Oct 22, 2008
Gwendolyn a Robinson Individual W-2 Managing EmployeeFacility Administrator Jun 21, 2021 100%
Lisa P Hamby Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Oct 22, 2008 31.37%
Neil Little Pruitt Individual Corporate OfficerChairman and Ceo Oct 22, 2008 100%
Corporate DirectorChairman and Ceo Oct 22, 2008 100%
Operational/Managerial ControlChairman and Ceo Oct 22, 2008 100%
OtherChain Home Office Admin, Ao Oct 22, 2008 100%
United Health Services of South Carolina Inc Organization, Norcross, GA Corporation, For-profit 5% Or Greater Direct Ownership Interest Oct 22, 2008 99%
Neil L Pruitt Jr Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Oct 22, 2008 36.12%
Uhs-Pruitt Holdings, Inc. Organization, Norcross, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 22, 2008 99%
J Paige Pruitt Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Oct 22, 2008 30.39%

Facilities with the same owner 122

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

View all 122

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1232409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1104063718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 JEURGENS CT",
            "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": "439 NORTH ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290031330",
            "telephone_number": "803-245-7525",
            "fax_number": "803-245-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH - BAMBERG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-20",
        "last_updated": "2014-06-30",
        "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": "770-279-6200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108093",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PruittHealth - Bamberg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bamberg, SC

Sources for this page

Verify at the official NPI Registry.