Active NPI
Pruitthealth - Old Capitol, LLC
Doing business as PruittHealth - Old Capitol
- Skilled Nursing Facility
- Louisville, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1-081-1569
- Legal business name
- PRUITTHEALTH - OLD CAPITOL, LLC
- Doing business as
- PruittHealth - Old Capitol
- Practice address
- 310 Highway 1 Bypass
Louisville, GA 30434-6432 - Phone
- (478) 625-3741
- Fax
- (478) 625-9473
- NPI assigned
- May 29, 2006
- Last updated
- Apr 7, 2021
- Organization subpart
- No
NPPES NPI Registry
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 of Manager
- Phone
- (770) 279-6200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1-081-1569 | GA | Primary |
Addresses
Primary practice location
310 Highway 1 Bypass
Louisville, GA 30434-6432
Mailing address
1626 Jeurgens CT
Legal Dept
Norcross, GA 30093-2219
Phone (678) 533-6485
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00142304A | Medicaid | GA |
Other names 1
- PruittHealth - Old Capitol
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050428000104 | GA | Part A Provider - Skilled Nursing Facility | 4284673377 | Practice locations: Louisville, GA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1467409987. Details of each certification follow.
Skilled nursing facility certification: CCN 115681
- Legal name
- PRUITTHEALTH - OLD CAPITOL, LLC
- Doing business as
- PRUITTHEALTH - OLD CAPITOL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 30, 2003
- Last certification
- May 23, 2024
- Beds
- 143
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Sep 25, 2007 in GA
- Enrollment address
- 310 US Highway 1 Byp S
Louisville, GA 30434-6432 - Nursing home name
- PRUITTHEALTH - OLD CAPITOL
- Affiliated entity
- PRUITTHEALTH
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pruitthealth - Old Capitol
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 30, 2003
- Medicare certification status
- Active
- Certified beds
- 143
- Chain
- Pruitthealth
- Penalties (3 years)
- 4
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0645917 | Pruitthealth - Old Capitol | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| United Health Services Inc | 5% Or Greater Indirect Ownership Interest | Mar 27, 2008 | 100% |
| Pruitthealth Inc | Other | Sep 25, 2007 | |
| Lisa P Hamby Trust | 5% Or Greater Indirect Ownership Interest | Sep 25, 2007 | 26.13% |
| Neil Little Pruitt | Corporate Officer | Sep 25, 2007 | 100% |
| Corporate Director | Sep 25, 2007 | 100% | |
| Operational/Managerial Control | Sep 25, 2007 | ||
| Other | Sep 25, 2007 | 100% | |
| Neil L Pruitt Jr Trust | 5% Or Greater Indirect Ownership Interest | Sep 25, 2007 | 35.2% |
| Tracy Brown | W-2 Managing Employee | May 31, 2021 | 100% |
| Uhs-Pruitt Holdings, Inc. | 5% Or Greater Indirect Ownership Interest | Mar 27, 2008 | 100% |
| United Health Services of Georgia, Inc. | 5% Or Greater Direct Ownership Interest | Mar 27, 2008 | 99% |
| J Paige Pruitt Trust | 5% Or Greater Indirect Ownership Interest | Sep 25, 2007 | 28.84% |
Facilities with the same owner 123
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba PruittHealth - Ashburn
- Skilled Nursing Facility
- Ashburn, GA
- NPI 1851347108
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.
-
dba PruittHealth - Athens Heritage
- Skilled Nursing Facility
- Athens, GA
- NPI 1316993769
J Paige Pruitt Trust, Lisa P Hamby Trust
-
dba PruittHealth - Augusta Hills
- Skilled Nursing Facility
- Augusta, GA
- NPI 1235186974
United Health Services Inc
-
dba PruittHealth - Augusta
- Skilled Nursing Facility
- Augusta, GA
- NPI 1295908846
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.
-
dba PruittHealth - Austell
- Skilled Nursing Facility
- Austell, GA
- NPI 1386690642
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.
-
dba PruittHealth - Bethany
- Skilled Nursing Facility
- Millen, GA
- NPI 1184924458
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.
-
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.
-
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.
-
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.
-
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.
-
- Skilled Nursing Facility
- Augusta, GA
- NPI 1104536077
United Health Services of Georgia, Inc.
-
- 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.
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Internal Medicine Physician
- Louisville, GA
- NPI 1245590793
-
- Internal Medicine Physician
- Martinez, GA
- NPI 1093758724
-
- Family Medicine Physician
- Walterboro, SC
- NPI 1497974273
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": "1148860800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1617753600000",
"number": "1467409987",
"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": "678-533-6485",
"fax_number": "770-931-5278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 HIGHWAY 1 BYPASS",
"city": "LOUISVILLE",
"state": "GA",
"postal_code": "304346432",
"telephone_number": "478-625-3741",
"fax_number": "478-625-9473"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRUITTHEALTH - OLD CAPITOL, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-29",
"last_updated": "2021-04-07",
"certification_date": "2021-03-17",
"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 OF MANAGER",
"authorized_official_telephone_number": "770-279-6200",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "GA",
"license": "1-081-1569",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00142304A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PruittHealth - Old Capitol",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PruittHealth - Old Capitol",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Louisville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.