NPIMap

Organization Active NPI

Pruitthealth - Creekside, LLC

  • Skilled Nursing Facility
  • Augusta, GA
National Provider Identifier
1104536077
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PRUITTHEALTH - CREEKSIDE, LLC
Practice address
2021 Scott Rd
Augusta, GA 30906-2539
Phone
(770) 279-6200
NPI assigned
Dec 1, 2022
Last updated
Dec 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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) 279-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2021 Scott Rd
Augusta, GA 30906-2539

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231209000682 GA Part A Provider - Skilled Nursing Facility 6305293770 Practice locations: Augusta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104536077. Details of each certification follow.

Skilled nursing facility certification: CCN 115777

Legal name
PRUITTHEALTH - CREEKSIDE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 12, 2024
Last certification
May 4, 2025
Beds
193
Ownership / control type
Corporation
Multi-facility organization
Pruitthealth
Organization structure
LLCProprietary
Incorporated
May 1, 2022 in GA
Enrollment address
2021 Scott Rd
Augusta, GA 30906-2539
Nursing home name
PRUITTHEALTH - CREEKSIDE
Affiliated entity
PRUITTHEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pruitthealth - CreeksideCCN 115777 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Apr 12, 2024
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
19382.4 residents per day on average
Chain
Pruitthealth95 facilities in the chain

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
11D2271213Pruitthealth-Creekside, LLC2021 Scott Road, Augusta, GA 30906Certificate of waiverOct 30, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Organization, Norcross, GA Indirect Ownership Interest Aug 12, 2020 2.4%
Organization, Norcross, GA Adp of the SNF Jan 14, 2025
Indirect Ownership Interest Jan 14, 2025 1.59%
United Health Services Inc Organization, Norcross, GA Corporation, Holding company Indirect Ownership Interest Sep 1, 2022 100%
Philip W. Small Individual Corporate DirectorDirector Jan 3, 2011
Individual Adp of the SNF Nov 11, 2019
Lisa P Hamby Trust Organization, Norcross, GA Adp of the SNF Jun 22, 2021
Indirect Ownership Interest Jun 22, 2021 22.98%
Neil Little Pruitt Individual Corporate OfficerChairman and Ceo Nov 27, 2013 1%
Direct Ownership Interest Nov 27, 2013 1%
Neil L Pruitt Jr Trust Organization, Norcross, GA Adp of the SNF Jun 22, 2021
Indirect Ownership Interest Jun 22, 2021 42.86%
NWP 2020 Child TR Fbo Neil L Pruitt Jr Organization, Norcross, GA Adp of the SNF Aug 12, 2020
Indirect Ownership Interest Aug 12, 2020 6.29%
Luther M Thomas Individual Operational/Managerial Control Nov 12, 2023
Adp of the SNF Nov 17, 2025
Individual Adp of the SNF Aug 5, 2011
Nancy W Pruitt Individual Managing Control - Governing BodyDirector Nov 27, 2013
Jessica Love Individual Operational/Managerial Control Oct 10, 2022
Adp of the SNF Sep 12, 2025
Pruitthealth Consulting Services Inc Organization, Norcross, GA Corporation Adp of the SNF Nov 26, 2013
Individual Adp of the SNF Jun 1, 2008
Uhs-Pruitt Holdings, Inc. Organization, Norcross, GA Holding company Indirect Ownership Interest Sep 1, 2022
Organization, Norcross, GA Adp of the SNF Aug 12, 2020
Indirect Ownership Interest Aug 12, 2020 2.4%
United Health Services of Georgia, Inc. Organization, Norcross, GA Corporation, Holding company 5% Or Greater Direct Ownership Interest Nov 27, 2013 99%
Direct Ownership Interest Sep 1, 2022 99%
J Paige Pruitt Trust Organization, Norcross, GA Adp of the SNF Jun 22, 2021
Indirect Ownership Interest Jun 22, 2021 21.44%

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 88

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

View all 88

Practitioners & affiliated clinicians

Practitioners 2

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 2

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": "1669852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1104536077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 JEURGENS CT",
            "address_2": "ATTN: LEGAL DEPT",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30093",
            "telephone_number": "770-279-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 SCOTT RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309062539",
            "telephone_number": "770-279-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH - CREEKSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "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_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.