Provider Demographics
NPI:1477176204
Name:PRISTINE HOSPICE INC
Entity Type:Organization
Organization Name:PRISTINE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-297-1165
Mailing Address - Street 1:400 N MOUNTAIN AVE STE 123B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5176
Mailing Address - Country:US
Mailing Address - Phone:909-297-1167
Mailing Address - Fax:909-297-1167
Practice Address - Street 1:400 N MOUNTAIN AVE STE 123B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5176
Practice Address - Country:US
Practice Address - Phone:909-297-1167
Practice Address - Fax:909-297-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based