Healthcare Provider Details

I. General information

NPI: 1215618442
Provider Name (Legal Business Name): PRISTINE JOURNEY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 NE 134TH ST
NORTH MIAMI FL
33161-4252
US

IV. Provider business mailing address

1175 NE 134TH ST
NORTH MIAMI FL
33161-4252
US

V. Phone/Fax

Practice location:
  • Phone: 305-748-7950
  • Fax:
Mailing address:
  • Phone: 305-748-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VANESSA JOHNSON PIERRE
Title or Position: CEO
Credential:
Phone: 305-748-7950