Provider Demographics
NPI:1265902399
Name:PRISTINE ADULT DAY CARE, LLC
Entity type:Organization
Organization Name:PRISTINE ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GURU
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-545-4743
Mailing Address - Street 1:6360 FLANK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6360 FLANK DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2766
Practice Address - Country:US
Practice Address - Phone:717-545-4743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care