Provider Demographics
NPI:1659029379
Name:PRISTINE HOSPICE LLC
Entity Type:Organization
Organization Name:PRISTINE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ISIDERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-343-8045
Mailing Address - Street 1:8607 N 59TH AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5434
Mailing Address - Country:US
Mailing Address - Phone:480-343-8045
Mailing Address - Fax:
Practice Address - Street 1:8607 N 59TH AVE STE A1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5434
Practice Address - Country:US
Practice Address - Phone:480-343-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based