Healthcare Provider Details

I. General information

NPI: 1346601556
Provider Name (Legal Business Name): PRISTINE HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAIN ST STE 353
WORCESTER MA
01608-1606
US

IV. Provider business mailing address

340 MAIN ST STE 353
WORCESTER MA
01608-1606
US

V. Phone/Fax

Practice location:
  • Phone: 510-205-5422
  • Fax:
Mailing address:
  • Phone: 510-205-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL TEMBO
Title or Position: MANAGER
Credential:
Phone: 510-205-5422