PRUITTHEALTH - OLD CAPITOL, LLC (NPI# 1467409987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467409987 |
| Entity Type | Organization |
| Organization Name | PRUITTHEALTH - OLD CAPITOL, LLC |
| Other Organization Name | PRUITTHEALTH - OLD CAPITOL |
| Practice Address |
310 Highway 1 Bypass Louisville GA 30434-6432 |
| Mailing Address |
1626 Jeurgens Ct Norcross GA 30093-2219 |
| Practice Telephone | 4786253741 |
| Mailing Telephone | 6785336485 |
| Mailing Fax Number | 7709315278 |
| Enumeration Date | 2006-05-29 |
| Last Update Date | 2014-07-02 |
| Authorized Official Name | NEIL L PRUITT JR. (CHAIRMAN AND CEO OF MANAGER) |
| Authorized Official Telephone | 7702796200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 1-081-1569 | GA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00142304A | 05 |
| Other Name | Type Code |
|---|---|
| PruittHealth - Old Capitol | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRUITTHEALTH - OLD CAPITOL, LLC | 310 Hwy 1 Bypass, Louisville, GA 30434 |
| Street Address |
310 HIGHWAY 1 BYPASS |
| City | LOUISVILLE |
| State | GA |
| Zip Code | 30434-6432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255503934 | Tonya M Gunby Dmd PC | Dentist | 502 Screven Street, Louisville, GA 30434 | 2008-04-02 |
| 1023187564 | Bobbie W. Jones | Registered Nurse | 2501 Hwy 1 N, Louisville, GA 30434 | 2006-11-07 |
| 1083797898 | Catherine Cates Rabun | Registered Nurse | 2501 U. S. Hwy 1 N, Louisville, GA 30434 | 2006-10-23 |
| 1659461028 | Shirlee T. Johnson | Registered Nurse | 2501highway 1 N, Louisville, GA 30434 | 2006-10-13 |
| 1033209572 | Janet Raines Pilcher | Registered Nurse | 2501 Highway One North, Louisville, GA 30434 | 2006-10-13 |
| 1760420202 | Andrea Byrd Doak | Physician Assistant | 1067 Peachtree St, Louisville, GA 30434 | 2006-06-04 |
| 1205889623 | Jefferson County Board of Health | Public Health or Welfare | 2501 U.S. Highway # 1 North, Louisville, GA 30434 | 2006-05-18 |
| 1467631648 | Kimberly J Clarkbrake | Registered Nurse | 2501 Highway One North, Louisville, GA 30434 | 2007-10-24 |
| 1114003241 | Mary Ellen Chalker | Registered Nurse | 2501 Highway One North, Louisville, GA 30434 | 2006-10-31 |
| 1376787499 | Positive Choice...a Step In The Right Direction | Community/Behavioral Health | 480 Forrest Dr, Louisville, GA 30434-1348 | 2009-04-21 |
| Find all providers in zip 30434 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255980876 | Ehcs Oakhill Properties, LLC | Skilled Nursing Facility | 4466 Lynnhaven Ave, Louisville, OH 44641-9513 | 2019-09-06 |
| 1740710623 | Landmark of Louisville Rehabilitation and Nursing Center | Skilled Nursing Facility | 1155 Eastern Parkway, Louisville, KY 40217 | 2017-06-14 |
| 1225405475 | Blount County Snf Operations, LLC | Skilled Nursing Facility | 1965 Stewart Lane, Louisville, TN 37777 | 2015-08-24 |
| 1952788408 | Bridgett Powers Mattingly | Skilled Nursing Facility | 117 Weisser Ave, Louisville, KY 40206-2761 | 2015-05-05 |
| 1235527300 | Trilogy Healthcare of Louisville Northeast, LLC | Skilled Nursing Facility | 4120 Wooded Acre Ln, Louisville, KY 40245-2938 | 2014-12-24 |
| 1215330345 | Jonathan Kratzwald | Skilled Nursing Facility | 8206 Happiness Way, Louisville, KY 40291-2865 | 2014-10-03 |
| 1043659626 | Niraj Mathur | Skilled Nursing Facility | 4209 Bridlepath Pl, Louisville, KY 40245-1971 | 2013-06-18 |
| 1235574161 | Balfour Retirement Community of Boulder County | Skilled Nursing Facility | 1855 Plaza Dr., Louisville, CO 80027 | 2013-05-06 |
| 1164703955 | Christian Health Center - West, Inc. | Skilled Nursing Facility | 1015 Magazine St, Louisville, KY 40203-2017 | 2011-09-07 |
| 1801193560 | Trilogy Healthcare of Louisville East, LLC | Skilled Nursing Facility | 4247 Westport Rd, Louisville, KY 40207-2227 | 2011-02-16 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 30434 |
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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.