Pruitthealth - Seaside, LLC
Organization Active NPI Skilled Nursing Facility · Port Wentworth, GA
NPI 1922575679 · NPPES record last updated Oct 31, 2018
Key facts
- NPI
- 1922575679
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PRUITTHEALTH - SEASIDE, LLC
- Practice address
- 1000 Dorset Rd
Port Wentworth, GA 31407-1517 - Phone
- (912) 964-1515
- NPI assigned
- Oct 31, 2018
- Organization subpart
- No
Authorized official
- Name
- Neil L. Pruitt Jr.
- Title
- Chairman and Ceo of Manager
- Phone
- (770) 279-6200
Facilities with the same owner 122
Practitioners 2
-
Vlastimil Smetka, MD
-
Rhonda L Wallace, MD
Affiliated clinicians 1
-
Vlastimil Smetka, MD
Medicare Care Compare: Nursing home
- Listed as
- Pruitthealth - Seaside
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 1, 1993
- Medicare certification status
- Active
- Certified beds
- 101 · 76.6 residents per day on average
- Chain
- Pruitthealth
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0264892 | Pruitthealth - Seaside, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Skilled nursing facility certification: CCN 115547
- Legal name
- PRUITTHEALTH - SEASIDE, LLC
- Doing business as
- PRUITTHEALTH - SEASIDE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1993
- Last certification
- Jan 7, 2024
- Beds
- 101
- Ownership / control type
- Corporation
- Multi-facility organization
- PRUITTHEALTH
- Organization structure
- LLC · Proprietary
- Incorporated
- May 25, 2018 in GA
- Enrollment address
- 1000 Dorset Rd
Port Wentworth, GA 31407-1517 - Nursing home name
- PRUITTHEALTH - SEASIDE
- Affiliated entity
- PRUITTHEALTH
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Uhs- Pruitt Holdings Inc |
5% Or Greater Indirect Ownership Interest | May 25, 2018 | 100% |
| United Health Services Inc |
5% Or Greater Indirect Ownership Interest | May 25, 2018 | 100% |
| Pruitthealth Inc |
Other | May 25, 2018 | |
| Lisa P Hamby Trust |
5% Or Greater Indirect Ownership Interest | May 25, 2018 | 26.13% |
| Neil Little Pruitt |
Corporate Officer |
May 25, 2018 | 100% |
| Corporate Director |
May 25, 2018 | 100% | |
| Operational/Managerial Control |
May 25, 2018 | 100% | |
| Other |
May 25, 2018 | 100% | |
| Tracey Nelson |
W-2 Managing Employee |
Feb 28, 2022 | 100% |
| Neil L Pruitt Jr Trust |
5% Or Greater Indirect Ownership Interest | May 25, 2018 | 35.2% |
| United Health Services of Georgia, Inc. |
5% Or Greater Direct Ownership Interest | May 25, 2018 | 99% |
| J Paige Pruitt Trust |
5% Or Greater Indirect Ownership Interest | May 25, 2018 | 28.84% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190109001365 | GA | Part a Provider - Skilled Nursing Facility | 6608112818 | Practice locations: Port Wentworth, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1000 Dorset Rd
Port Wentworth, GA 31407-1517
Mailing address
1626 Jeurgens CT
Norcross, GA 30093-2219
Phone (770) 279-6200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00143536A | Medicaid | GA |
Other names
- PruittHealth - Seaside
Other providers in Port Wentworth, GA
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All providers in Port Wentworth, GA · Skilled Nursing Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.