Healthcare Provider Details

I. General information

NPI: 1326623877
Provider Name (Legal Business Name): PRISTINE CARE HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 SOUTHWYCK BLVD STE 200F
TOLEDO OH
43614-1566
US

IV. Provider business mailing address

5660 SOUTHWYCK BLVD STE 200F
TOLEDO OH
43614-1566
US

V. Phone/Fax

Practice location:
  • Phone: 567-742-7170
  • Fax: 567-742-7270
Mailing address:
  • Phone: 567-742-7170
  • Fax: 567-742-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. GOLDA OSEI
Title or Position: ADMINISTRATOR
Credential:
Phone: 567-742-7170