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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 00140973A | 05 |
Other Name | Type Code |
---|---|
PruittHealth Community Services - Blue Ridge | Doing Business As Name - Organization |
Street Address |
74 OUIDA STREET |
City | BLUE RIDGE |
State | GA |
Zip Code | 30513 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801951603 | Blue Ridge Health Care Center, Inc. | Clinic/Center | 74 Ouida Street, Blue Ridge, GA 30577 | 2006-12-22 |
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 Code | 311ZA0620X |
Grouping | Nursing & Custodial Care Facilities |
Classification | Custodial Care Facility |
Specialization | Adult Care Home |
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] |
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 |
Find all providers with the same taxonomy |
City | BLUE RIDGE |
Zip Code | 30513 |
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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.