Provider Demographics
NPI:1295357259
Name:PRISTINE HOUSE LLC
Entity Type:Organization
Organization Name:PRISTINE HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:425-835-6512
Mailing Address - Street 1:25223 146TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3410
Mailing Address - Country:US
Mailing Address - Phone:425-835-6512
Mailing Address - Fax:253-236-8730
Practice Address - Street 1:25223 146TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-3410
Practice Address - Country:US
Practice Address - Phone:253-236-5352
Practice Address - Fax:253-236-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2139440Medicaid