NPIMap

Organization Active NPI

Pruitthealth Home Health, Inc.

Doing business as PruittHealth @ Home Jacksonville

  • Home Health Agency
  • Jacksonville, FL
National Provider Identifier
1922718774
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PRUITTHEALTH HOME HEALTH, INC.
Doing business as
PruittHealth @ Home Jacksonville
Practice address
4250 Lakeside Dr
Jacksonville, FL 32210-3358
Phone
(833) 679-5232
NPI assigned
Dec 2, 2022
Last updated
Oct 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lynethia Nytonya Holley
Title
Provider Enrollment Specialist
Phone
(786) 296-0751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

4250 Lakeside Dr
Jacksonville, FL 32210-3358

Mailing address

1626 Jeurgens CT
Norcross, GA 30093-2219
Phone (678) 296-0751

Other names 1

  • PruittHealth @ Home Jacksonville Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230719002698 FL Part A Provider - Home Health Agency 9032151246 Practice locations: Jacksonville, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922718774. Details of each certification follow.

Home health agency certification: CCN 687295

Legal name
PRUITTHEALTH HOME HEALTH, INC.
Doing business as
PRUITTHEALTH @HOME - JACKSONVILLE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 19, 2023
Last certification
Oct 19, 2023
Organization structure
CorporationProprietary
Incorporated
Apr 12, 1999 in GA
Enrollment address
4250 Lakeside Dr
Ste 116
Jacksonville, FL 32210-3300

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Pruitthealth @ Home- JacksonvilleCCN 687295 · All quality measures
Overall star rating
3.5 of 5
Ownership
-
Certified
Oct 19, 2023
Medicare certification status
ActiveFrom the Provider of Services file

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
10D2272362Pruitthealth Home Health, Inc4250 Lakeside Dr - Ste 214, Jacksonville, FL 32210Certificate of waiverNov 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pruitthealth Home Health Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

4250 Lakeside Dr
Jacksonville, FL 32210
Phone (833) 679-5232

4250 Lakeside Dr
Ste 214
Jacksonville, FL 32210

5004 Appalachian Hwy
Ste 3B
Blue Ridge, GA 30513
Phone (706) 632-6898

6050 Appalachian Hwy
Blue Ridge, GA 30513
Phone (706) 632-0027

85 Crye Leike Dr
Fort Oglethorpe, GA 30742
Phone (706) 861-8182

2545 Flintridge Rd
Gainesville, GA 30501
Phone (770) 533-7410

6340 Lake Oconee Pkwy
Ste 102
Greensboro, GA 30642
Phone (706) 454-1770

226 Alcovy St
Ste F
Monroe, GA 30655
Phone (404) 297-9924

500 Great Oaks Dr
#1012
Monroe, GA 30655
Phone (770) 267-2537

31 Three Rivers Dr NE
Rome, GA 30161
Phone (706) 232-5908

312 Canna Dr
Valdosta, GA 31602
Phone (229) 241-8750

340 Resource Way
Winder, GA 30680
Phone (770) 586-5313

416 McCullough Dr
Ste 235
Charlotte, NC 28262
Phone (704) 548-7730

3616 Mitchell Ave
Ste 56
Newland, NC 28657
Phone (828) 733-1550

30 Physician Dr
Aiken, SC 29801
Phone (803) 339-8214

240 Stoneridge Dr
Ste 100
Columbia, SC 29210
Phone (803) 626-0089

139 Gateway Dr
Ladson, SC 29456
Phone (843) 534-5007

950 48th Ave N
Ste 102
Myrtle Beach, SC 29577
Phone (843) 353-1152

Ownership & related parties

All disclosed owners & managing parties 13

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 Jan 2, 2006 100%
Philip W. Small Individual Corporate DirectorDirector Oct 5, 2016
Pruitthealth Inc Organization, Norcross, GA Operational/Managerial Control Jan 2, 2006
Lisa P Hamby Trust Organization, Norcross, GA Other Jan 2, 2006 28.43%
Neil Little Pruitt Individual Corporate OfficerChairman and Ceo Jan 2, 2006
Corporate DirectorDirector May 27, 2005
OtherChain Home Office Admin Jan 2, 2006
NWP 2020 Child TR Fbo Neil L Pruitt Jr Organization, Norcross, GA Other Jan 2, 2006 6%
Nancy W Pruitt Individual Corporate Officer Apr 12, 1999
Neil L Pruitt Jr Trust Organization, Norcross, GA Other Jan 2, 2006 37.43%
Uhs-Pruitt Holdings, Inc. Organization, Norcross, GA Corporation 5% Or Greater Indirect Ownership Interest Jan 2, 2006 100%
Thomas R Beddingfield Individual Corporate DirectorDirector Oct 5, 2016
United Health Services of Georgia, Inc. Organization, Norcross, GA Corporation 5% Or Greater Direct Ownership Interest Jan 2, 2006 100%
J Paige Pruitt Trust Organization, Norcross, GA Other Jan 2, 2006 26.7%
Melissa Udekwu Individual W-2 Managing EmployeeNursing Home Administrator Jan 31, 2023

Facilities with the same owner 121

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

View all 121

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.

NPI Registry JSON

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

{
    "created_epoch": "1669939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761177600000",
    "number": "1922718774",
    "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": "678-296-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 LAKESIDE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103358",
            "telephone_number": "833-679-5232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-02",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "LYNETHIA",
        "authorized_official_middle_name": "NYTONYA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "786-296-0751"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PruittHealth @ Home Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.