Active NPI
Pruitthealth - Valdosta, LLC
- Skilled Nursing Facility
- Valdosta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- PRUITTHEALTH - VALDOSTA, LLC
- Practice address
- 2501 N Ashley St
Valdosta, GA 31602-1820 - Phone
- (229) 244-7368
- NPI assigned
- Jun 3, 2020
- Last updated
- Jun 3, 2020
- 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
- Phone
- (770) 279-6200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
2501 N Ashley St
Valdosta, GA 31602-1820
Mailing address
1626 Jeurgens Court
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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210218002296 | GA | Part A Provider - Skilled Nursing Facility | 1456766740 | Practice locations: Valdosta, GA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1770107914. Details of each certification follow.
Skilled nursing facility certification: CCN 115377
- Legal name
- PRUITTHEALTH - VALDOSTA, LLC
- Doing business as
- PRUITTHEALTH - VALDOSTA
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 15, 1989
- Last certification
- Sep 15, 2023
- Beds
- 98
- Ownership / control type
- Corporation
- Multi-facility organization
- Pruitthealth
- Organization structure
- LLC
- Incorporated
- Apr 22, 2020 in GA
- Enrollment address
- 2501 N Ashley St
Valdosta, GA 31602-1820 - Nursing home name
- PRUITTHEALTH - VALDOSTA, LLC
- Affiliated entity
- PRUITTHEALTH
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pruitthealth - Valdosta, LLC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jun 15, 1989
- Medicare certification status
- Active
- Certified beds
- 98
- Chain
- Pruitthealth
National Provider Directory
National Provider DirectoryLocations
2501 N Ashley St
Valdosta, GA 31602
Phone (229) 224-7368
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.
| Name | Role | Since | Share |
|---|---|---|---|
| George R Brown | W-2 Managing Employee | Jun 24, 2021 | 100% |
| United Health Services Inc | 5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 100% |
| Charles Jackson | W-2 Managing Employee | Mar 1, 2021 | 100% |
| Pruitthealth Inc | Other | Aug 1, 2020 | 100% |
| Lisa P Hamby Trust | 5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 31.93% |
| Neil Little Pruitt | Corporate Director | Apr 22, 2020 | 100% |
| Operational/Managerial Control | Apr 22, 2020 | 100% | |
| Other | Apr 22, 2020 | ||
| Neil L Pruitt Jr Trust | 5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 37.64% |
| Uhs-Pruitt Holdings, Inc. | 5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 100% |
| United Health Services of Georgia, Inc. | 5% Or Greater Direct Ownership Interest | Apr 22, 2020 | 99% |
| J Paige Pruitt Trust | 5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 29.37% |
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 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.
-
- Internal Medicine Physician
- Valdosta, GA
- NPI 1649432733
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": "1591142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1591142400000",
"number": "1770107914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1626 JEURGENS COURT",
"address_2": "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": "2501 N ASHLEY ST",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021820",
"telephone_number": "229-244-7368"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRUITTHEALTH - VALDOSTA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-06-03",
"last_updated": "2020-06-03",
"certification_date": "2020-06-03",
"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",
"authorized_official_telephone_number": "770-279-6200",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
- Pro-Active Physical Therapy and Diagnostics
- Pruitthealth - Crestwood, LLC
- Pruitthealth - Holly Hill, LLC
- Pruitthealth - Lakehaven, LLC
- Pruitthealth - Parkwood, LLC
- Pruitthealth Home First, Inc. (Pruitthealth Home First - Valdosta)
- Pruitthealth Home Health - South Georgia II Inc (PruittHealth @ Home Valdosta)
- Pruitthealth Home Health, Inc. (PruittHealth @ Home - Valdosta)
- Pruitthealth Hospice, Inc (Pruitthealth Hospice - Valdosta)
- Pruitthealth Pharmacy Services - Valdosta, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.