Healthcare Provider Details

I. General information

NPI: 1215705645
Provider Name (Legal Business Name): PRISTINE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/17/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 INTERLAKE AVE N UNIT D
SEATTLE WA
98103-4029
US

IV. Provider business mailing address

1329 N 47TH ST # 31507
SEATTLE WA
98103-9998
US

V. Phone/Fax

Practice location:
  • Phone: 206-571-6983
  • Fax:
Mailing address:
  • Phone: 206-571-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN GITONGA KARIUNGI
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 206-571-6983