Pruitthealth - Holly Hill, LLC
Organization Active NPI Skilled Nursing Facility · Valdosta, GA
NPI 1972127116 · NPPES record last updated Jun 3, 2020
Key facts
- NPI
- 1972127116
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PRUITTHEALTH - HOLLY HILL, LLC
- Practice address
- 413 Pendleton PL
Valdosta, GA 31602-2632 - Phone
- (229) 244-6968
- NPI assigned
- Jun 3, 2020
- Organization subpart
- No
Authorized official
- Name
- Neil L Pruitt Jr.
- Title
- Chaiman and Ceo
- Phone
- (770) 279-6200
Facilities with the same owner 123
Practitioners 1
-
Jarod Franklin Bailey, D.O.
Medicare Care Compare: Nursing home
- Listed as
- PruittHealth - Holly Hill, LLC
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 1, 1994
- Medicare certification status
- Active
- Certified beds
- 100 · 87.2 residents per day on average
- Chain
- Pruitthealth
- Penalties (3 years)
- 3 · fines totaling $19,145
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Skilled nursing facility certification: CCN 115562
- Legal name
- PRUITTHEALTH - HOLLY HILL, LLC
- Doing business as
- PRUITTHEALTH - HOLLY HILL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 1, 1994
- Last certification
- Nov 20, 2024
- Beds
- 100
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- PruittHealth
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 22, 2020 in GA
- Enrollment address
- 413 Pendleton PL
Valdosta, GA 31602-2632 - Nursing home name
- PRUITTHEALTH - HOLLY HILL, LLC
- Affiliated entity
- PRUITTHEALTH
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| United Health Services Inc |
5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 100% |
| Pruitthealth Inc |
Operational/Managerial Control | Apr 22, 2020 | 100% |
| Lisa P Hamby Trust |
5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 31.93% |
| Neil Little Pruitt |
Corporate Officer |
Apr 22, 2020 | 100% |
| Corporate Director |
Apr 22, 2020 | 100% | |
| Neil L Pruitt Jr Trust |
5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 37.63% |
| 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% |
| Nellie Wilson |
W-2 Managing Employee |
Aug 1, 2020 | 100% |
| J Paige Pruitt Trust |
5% Or Greater Indirect Ownership Interest | Apr 22, 2020 | 29.23% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210315001456 | GA | Part a Provider - Skilled Nursing Facility | 7416363536 | Practice locations: Valdosta, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
413 Pendleton PL
Valdosta, GA 31602-2632
Mailing address
1626 Jeurgens Court
Legal Dept
Norcross, GA 30093
Phone (770) 279-6200
Other providers in Valdosta, GA
- Leo David Pridgen Jr.
- Wanda Pritchett
- Private Healthcare Facilities
- Pro-Active Physical Therapy and Diagnostics
- Pruitthealth - Crestwood, LLC
- Pruitthealth - Lakehaven, LLC
- Pruitthealth - Parkwood, LLC
- Pruitthealth - Valdosta, LLC
- Pruitthealth Home First, Inc.
- Pruitthealth Home Health - South Georgia II Inc
All providers in Valdosta, 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 Jun 3, 2020. 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.