Pruitthealth - Blue Ridge LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

PRUITTHEALTH - BLUE RIDGE LLC

Doing business as

PruittHealth Community Services - Blue Ridge

Practice address

74 Ouida Street
Blue Ridge, GA 30513

Phone

(706) 258-2819

NPI assigned

Mar 13, 2007

Last updated

Jun 30, 2014By 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

Neil L. Pruitt Jr.

Title

Chairman and Ceo

Phone

(770) 279-6200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PruittHealth Community Services - Blue Ridge Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710010715. Details of each certification follow.

• CCN 115468 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 115468

Legal name

PRUITTHEALTH - BLUE RIDGE, LLC

Doing business as

PRUITTHEALTH - BLUE RIDGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 5, 1989

Last certification

Mar 7, 2024

Beds

101

Ownership / control type

Corporation

Multi-facility organization

Pruitthealth

Organization structure

LLCProprietary

Enrollment address

99 Ouida St
Blue Ridge, GA 30513-4627

Nursing home name

PRUITTHEALTH - BLUE RIDGE

Affiliated entity

PRUITTHEALTH

Other NPIs on the same Medicare enrollment 1

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

• Pruitthealth - Blue Ridge, LLC

  dba PruittHealth - Blue Ridge

  • Skilled Nursing Facility
  • Blue Ridge, GA
  • NPI 1730136599

  O20051205000362

  Same enrollment

Listed as

Pruitthealth - Blue RidgeCCN 115468 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jul 5, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10184.5 residents per day on average

Chain

Pruitthealth95 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 18

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Amar Mohan, MD

  • Internal Medicine Physician
  • Monroe, GA
  • NPI 1578724886

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Maxcene Oreus, MD

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1184707879

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1710010715",
    "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": "74 OUIDA STREET",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "30513",
            "telephone_number": "706-258-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH - BLUE RIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "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_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00140973A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PruittHealth Community Services - Blue Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William L Prather, LICENSED PHARMACIST
• Premier Ophthalmic Dispensary LLC
• Laura Nicole Presswood
• Pride Home Care Services LLC
• Sarah Smith Pruitt, PHARM.D.
• Pruitthealth - Blue Ridge, LLC (PruittHealth - Blue Ridge)
• Pruitthealth Home First, Inc. (Pruitthealth Home First - Blue Ridge)
• Pruitthealth Home Health, Inc. (PruittHealth @ Home - Blue Ridge)
• Pruitthealth Hospice, Inc. (PruittHealth Hospice - Blue Ridge)
• Kyle David Raque, PSY.D.

• Adult Care Home Facility in Blue Ridge, GA
• Providers in Blue Ridge, GA by specialty
• Adult Care Home Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; 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.

Verify at the official NPI Registry.