PRUITTHEALTH - BLUE RIDGE LLC
Adult Care Home
Blue Ridge, Georgia
Provider NPI: 1710010715
Organization Information:Organization Name: PRUITTHEALTH - BLUE RIDGE LLC
Practice Location:
74 OUIDA STREET BLUE RIDGE, GA 30513 US
Tel: 706-258-2819 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
74 OUIDA STREET BLUE RIDGE, GA 30513 US
Tel: 706-258-2819 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
00140973A | GA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin