Provider Demographics
NPI:1417549239
Name:PRISTINE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PRISTINE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-898-7767
Mailing Address - Street 1:1137 HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4828
Mailing Address - Country:US
Mailing Address - Phone:540-548-2958
Mailing Address - Fax:540-548-2935
Practice Address - Street 1:1137 HEATHERSTONE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4828
Practice Address - Country:US
Practice Address - Phone:540-548-2958
Practice Address - Fax:540-548-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health