Organization
PRUITTHEALTH - SANTA ROSA, LLC
Active
Other names
PruittHealth - Santa Rosa
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL L. PRUITT JR. (CHAIRMAN & CEO OF MGR)
(770) 279-6200
Entity
Organization
Contact information
Practice address
5530 NORTHROP ROAD, MILTON, FL 32570-8701
(850) 983-8888
(850) 983-8880
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
(706) 886-0542
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF130471024
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025933100
—
FL
Enumeration date
05/24/2006
Last updated
06/03/2021
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