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General NPI Number Information
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NPI Number | 1548804099
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Entity Type | Organization
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Legal Business Name | PRISTINE HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 14402 NEWBERN LOOP
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City | GAINESVILLE
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State | VA
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Zip | 20155-1479
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Country | US
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Telephone | 571-723-3289
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Fax |
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Provider Business Mailing Address
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Address Line | 14402 NEWBERN LOOP
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City | GAINESVILLE
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State | VA
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Zip | 20155-1479
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Country | US
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Telephone | 571-723-3289
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RITA MENSAH DOMFEH
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Credential |
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Telephone | 571-723-3289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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