Healthcare Provider Details

I. General information

NPI: 1184531410
Provider Name (Legal Business Name): PRISTINE HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2342 HILL ST APT H
PETERSBURG VA
23803-2774
US

IV. Provider business mailing address

744 W OGLETHORPE HWY UNIT 1184
HINESVILLE GA
31310-7749
US

V. Phone/Fax

Practice location:
  • Phone: 804-719-0026
  • Fax:
Mailing address:
  • Phone: 804-719-0026
  • Fax:

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: LONNIE REID JR.
Title or Position: ADMINISTER
Credential:
Phone: 912-719-0026