Organization Active NPI

Pruitthealth - Fort Oglethorpe, LLC

Doing business as PruittHealth - Fort Oglethorpe

  • Skilled Nursing Facility
  • Fort Oglethorpe, GA
National Provider Identifier
1508813023
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1023950 Issued in GA
Legal business name
PRUITTHEALTH - FORT OGLETHORPE, LLC
Doing business as
PruittHealth - Fort Oglethorpe
Practice address
1067 Battlefield Parkway
Fort Oglethorpe, GA 30742
Phone
(706) 861-5154
Fax
(706) 866-3230
NPI assigned
May 29, 2006
Last updated
Jun 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 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 of Manager
Phone
(770) 279-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1023950 GA Primary

Addresses

Primary practice location

1067 Battlefield Parkway
Fort Oglethorpe, GA 30742

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00214695AMedicaidGA

Other names 1

  • PruittHealth - Fort Oglethorpe Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050824000316 GA Part A Provider - Skilled Nursing Facility 2769413319 Practice locations: Fort Oglethorpe, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508813023. Details of each certification follow.

Skilled nursing facility certification: CCN 115409

Legal name
PRUITTHEALTH - FORT OGLETHORPE, LLC
Doing business as
PRUITTHEALTH - FORT OGLETHORPE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1989
Last certification
Sep 12, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
United Health Services of Georgia, Inc.
Organization structure
LLCProprietary
Incorporated
Sep 24, 2007 in GA
Enrollment address
1067 Battlefield Pkwy
Fort Oglethorpe, GA 30742-3947
Nursing home name
PRUITTHEALTH - FORT OGLETHORPE
Affiliated entity
PRUITTHEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pruitthealth - Fort OglethorpeCCN 115409 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120100.6 residents per day on average
Chain
Pruitthealth95 facilities in the chain
Penalties (3 years)
2Fines totaling $10,699

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
11D0262504Pruitthealth Fort Oglethorpe, LLC1067 Battlefield Parkway, Fort Oglethorpe, GA 30742Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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 Corporation 5% Or Greater Indirect Ownership Interest Sep 24, 2007 99%
Pruitthealth Inc Organization, Toccoa, GA For-profit Operational/Managerial Control Sep 24, 2007 99%
Lisa P Hamby Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Sep 24, 2007 31.33%
Neil Little Pruitt Individual Operational/Managerial ControlCho Administrator Sep 24, 2007
Laura Lee Backus Individual W-2 Managing EmployeeFacility Administrator Nov 26, 2019 100%
Neil L Pruitt Jr Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Sep 24, 2007 35.57%
Uhs-Pruitt Holdings, Inc. Organization, Norcross, GA For-profit 5% Or Greater Indirect Ownership Interest Sep 24, 2007 99%
Kevin Crickard Individual W-2 Managing EmployeeFacility Administrator Jan 6, 2020 100%
United Health Services of Georgia, Inc. Organization, Norcross, GA For-profit 5% Or Greater Direct Ownership Interest Sep 24, 2007 99%
J Paige Pruitt Trust Organization, Norcross, GA 5% Or Greater Indirect Ownership Interest Sep 24, 2007 31.01%

Facilities with the same owner 123

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

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.

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": "1622678400000",
    "number": "1508813023",
    "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": "1067 BATTLEFIELD PARKWAY",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "30742",
            "telephone_number": "706-861-5154",
            "fax_number": "706-866-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH - FORT OGLETHORPE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-29",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "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": "1023950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00214695A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PruittHealth - Fort Oglethorpe",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PruittHealth - Fort Oglethorpe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Oglethorpe, GA

Sources for this page

Verify at the official NPI Registry.