Provider Demographics
NPI:1538294350
Name:PRISTINE HEALTH CARE INC
Entity Type:Organization
Organization Name:PRISTINE HEALTH CARE INC
Other - Org Name:LIFELINE AT HOME PRIVATE DUTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-447-2273
Mailing Address - Street 1:30 E SANTA CLARA ST STE H
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3235
Mailing Address - Country:US
Mailing Address - Phone:626-447-9603
Mailing Address - Fax:626-447-9657
Practice Address - Street 1:30 E SANTA CLARA ST STE H
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3235
Practice Address - Country:US
Practice Address - Phone:626-447-9603
Practice Address - Fax:626-447-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHHA08128F251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058128Medicare ID - Type UnspecifiedHOME HEALTH AGENCY