Pruitthealth Hospice, Inc.

Primary specialty

Inpatient HospiceTaxonomy code 315D00000X

Legal business name

PRUITTHEALTH HOSPICE, INC.

Doing business as

PruittHealth Hospice - Fayetteville

Practice address

2850 Village Dr Ste 102
Fayetteville, NC 28304-3864

Phone

(910) 483-1793

Fax

(910) 483-4315

NPI assigned

Feb 26, 2015

Last updated

Dec 21, 2020By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• PruittHealth Hospice - Fayetteville Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice and Palliative Care - Triangle

  • Community Based Hospice Care Agency
  • Rocky Mount, NC
  • NPI 1003853516

  O20220810003250

  Same enrollment
• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - New Bern

  • Inpatient Hospice
  • New Bern, NC
  • NPI 1750329116

  O20220810003250

  Same enrollment
• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - Wilkes

  • Community Based Hospice Care Agency
  • North Wilkesboro, NC
  • NPI 1881983419

  O20220810003250

  Same enrollment
• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - Eastern Carolina

  • Community Based Hospice Care Agency
  • Greenville, NC
  • NPI 1992744361

  O20220810003250

  Same enrollment

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1386036473",
    "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",
            "fax_number": "770-931-5278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 VILLAGE DR STE 102",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043864",
            "telephone_number": "910-483-1793",
            "fax_number": "910-483-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-26",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "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": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PruittHealth Hospice - Fayetteville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PruittHealth Hospice - Fayetteville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Provisions Behavioral Services (Provisions Community Support Services, LLC)
• Michele T Provost, PA
• Renee Mechelle Prows, LPCA
• Jackson Thomas Pruett, PT, DPT
• Lysiane Pruitt, FNP
• Kimberly Wilson Pryzgoda, DDS
• Publix North Carolina LP (Publix Pharmacy #2101)
• Publix North Carolina LP
• Tiffany Vick Puckett, LCSW
• Christine Pufnock, M.S., OTR L

• Inpatient Hospice in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Inpatient Hospice in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.