Pristine Care & Support Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

PRISTINE CARE & SUPPORT SERVICES LLC

Practice address

3121 Fire Rd Ste D310
Egg Harbor Township, NJ 08234-9619

Phone

(609) 224-1099

Fax

(609) 224-1099

NPI assigned

Jan 23, 2023

Last updated

Feb 7, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ventley Young

Title

Ceo

Phone

(609) 224-1099

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1013623107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 FIRE RD STE D310",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082349619",
            "telephone_number": "609-224-1099",
            "fax_number": "609-224-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 FIRE RD STE D310",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082349619",
            "telephone_number": "609-224-1099",
            "fax_number": "609-224-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE CARE & SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "VENTLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "609-224-1099",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Egg Harbor Township, NJ
• Providers in Egg Harbor Township, NJ by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.