MEDICARE: PRISTINE CARE HOME HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1326623877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISTINE CARE HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	5660 SOUTHWYCK BLVD STE 200F
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	567-742-7170
Fax Number	:	567-742-7270

Provider Business Practice Location Address
First Line	:	5660 SOUTHWYCK BLVD STE 200F
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	567-742-7170
Fax Number	:	567-742-7270

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GOLDA OSEI
Credential	:
Telephone Number	:	567-742-7170

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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