PRUITTHEALTH - BLUE RIDGE LLC


Address: 74 Ouida Street, Blue Ridge, GA 30513
Phone: 7062582819

PRUITTHEALTH - BLUE RIDGE LLC (NPI# 1710010715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1710010715
Entity Type Organization
Organization Name PRUITTHEALTH - BLUE RIDGE LLC
Other Organization Name PRUITTHEALTH COMMUNITY SERVICES - BLUE RIDGE
Practice Address 74 Ouida Street
Blue Ridge
GA 30513
Mailing Address 1626 Jeurgens Ct
Norcross
GA 30093-2219
Practice Telephone 7062582819
Mailing Telephone 7702796200
Enumeration Date 2007-03-13
Last Update Date 2014-06-30
Authorized Official Name NEIL L. PRUITT JR. (CHAIRMAN AND CEO)
Authorized Official Telephone 7702796200
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 311ZA0620X Custodial Care Facility
Specialization: Adult Care Home
Nursing & Custodial Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
GA 00140973A 05

Other Provider/Organization Names

Other Name Type Code
PruittHealth Community Services - Blue Ridge Doing Business As Name - Organization

Office Location

Street Address 74 OUIDA STREET
City BLUE RIDGE
State GA
Zip Code 30513

Providers in the same location

NPI Name Taxonomy Address Enumeration
1801951603 Blue Ridge Health Care Center, Inc. Clinic/Center 74 Ouida Street, Blue Ridge, GA 30577 2006-12-22

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1356804561 Christine Gangwisch Registered Nurse 3855 Old Highway 5 Ste 110, Blue Ridge, GA 30513 2019-04-13
1013474659 Ten Dental LLC Dentist 330 Progress Circle Ste C, Blue Ridge, GA 30513 2019-03-01
1932646262 David Lee Durham Pharmacist 5679 Appalachian Highway, Blue Ridge, GA 30513 2017-01-25
1659754398 Jordan Patton Ophthalmology 266 Orvin Lance Dr Ste 5, Blue Ridge, GA 30513 2015-06-30
1063824977 Christy Russell Pharmacist 97 Commerce Drive, Blue Ridge, GA 30513 2014-05-27
1588008429 Nathan William Kincaid Surgery 2855 Old Highway 5 Ste 108, Blue Ridge, GA 30513 2013-04-22
1972800175 W. Max Couch, Jr., Dds, Mds, LLC Dentist 2714 East First Street, Blue Ridge, GA 30513 2011-02-24
1760792246 Med-trans Corporation Ambulance 482 Mccaysville Industrial Dr, Blue Ridge, GA 30513 2010-10-18
1396924791 Sue Ann Richardson Chiropractor 59 Mckinney, Blue Ridge, GA 30513 2007-11-01
1164554432 Pruitthealth Home First, Inc. Case Management 6050 Appalachian Highway, Suite 4, Blue Ridge, GA 30513 2007-03-12
Find all providers in zip 30513

Taxonomy Information

Taxonomy Code 311ZA0620X
Grouping Nursing & Custodial Care Facilities
Classification Custodial Care Facility
Specialization Adult Care Home

Taxonomy Definition

A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
Notes: [7/1/2003: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1679174437 United Hands Support Services Custodial Care Facility 735 Ridge Rd, Canton, GA 30114-4170 2020-11-06
1679174429 Golden Peak Senior Living Corp Custodial Care Facility 411 Edmond St, Calhoun, GA 30701-5334 2020-11-06
1023615531 Lillian Womble Custodial Care Facility 3232 Union Church Road, Warthen, GA 31094 2020-10-07
1750995155 Jacqueline Dingle Custodial Care Facility 604 Sugarbush Cir, Savannah, GA 31406-4434 2020-09-02
1114549763 Idella's Angels Custodial Care Facility 270 13th Ave Sw, Cairo, GA 39828-3423 2020-05-16
1356962062 Brendas Love Personal Care Home LLC Custodial Care Facility 8239 Queens Dr, Jonesboro, GA 30238-2946 2020-05-04
1801421094 Lj's Personal Care Home, LLC Custodial Care Facility 415 E 18th St Sw, Rome, GA 30161-6544 2020-03-08
1356984041 Manuel Carl Mckenzie IIi Custodial Care Facility 4893 Candlewood Ln, Stone Mountain, GA 30088-1605 2019-10-24
1457904310 Renaissance Healthcare LLC Custodial Care Facility 419 Airport Rd, Griffin, GA 30224-4834 2019-07-19
1225697873 Tahirah Johnston Custodial Care Facility 1657 Hallmark Hills Dr, Griffin, GA 30223-8790 2019-06-07
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Competitor

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City BLUE RIDGE
Zip Code 30513

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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