Provider Demographics
NPI:1821551425
Name:PRISTINE HOME CARE LLC
Entity Type:Organization
Organization Name:PRISTINE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARAEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-595-0322
Mailing Address - Street 1:2640 COLLEGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1745
Mailing Address - Country:US
Mailing Address - Phone:248-595-0322
Mailing Address - Fax:248-595-0322
Practice Address - Street 1:3200 GREENFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1805
Practice Address - Country:US
Practice Address - Phone:248-595-0322
Practice Address - Fax:248-595-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821551425OtherNPI
MI1215434956OtherNPI