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General NPI Number Information
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NPI Number | 1295357259
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Entity Type | Organization
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Legal Business Name | PRISTINE HOUSE LLC
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 25223 146TH AVE SE
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City | KENT
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State | WA
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Zip | 98042-3410
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Country | US
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Telephone | 253-236-5352
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Fax | 253-236-8730
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Provider Business Mailing Address
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Address Line | 25223 146TH AVE SE
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City | KENT
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State | WA
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Zip | 98042-3410
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Country | US
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Telephone | 425-835-6512
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Fax | 253-236-8730
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Authorized Official
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Title or Position | RESIDENT MANAGER
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Name | MRS. ANITA KHADKA
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Credential | RN
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Telephone | 425-835-6512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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