Organization
PRUITTHEALTH - LAKEHAVEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL L. PRUITT JR. (CHAIRMAN AND CEO)
(770) 279-6200
Entity
Organization
Contact information
Practice address
410 NORTHSIDE DR, VALDOSTA, GA 31602-1802
(229) 242-7368
Mailing address
1626 JEURGENS COURT, LEGAL DEPT, NORCROSS, GA 30093
(770) 279-6200
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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