Provider Demographics
NPI:1376097865
Name:PRISTINE HOME CARE LLC
Entity Type:Organization
Organization Name:PRISTINE HOME CARE LLC
Other - Org Name:PHILADELPHIA PRISTINE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-255-0203
Mailing Address - Street 1:2210 MICHENER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4320
Mailing Address - Country:US
Mailing Address - Phone:215-969-4343
Mailing Address - Fax:215-969-5671
Practice Address - Street 1:2210 MICHENER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4320
Practice Address - Country:US
Practice Address - Phone:215-969-4343
Practice Address - Fax:215-969-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30743601251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care