Pristine House LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

PRISTINE HOUSE LLC

Practice address

25223 146TH Ave SE
Kent, WA 98042-3410

Phone

(253) 236-5352

Fax

(253) 236-8730

NPI assigned

May 13, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Anita Khadka, RN

Title

Resident Manager

Phone

(425) 835-6512

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Pristine House Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1295357259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25223 146TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980423410",
            "telephone_number": "425-835-6512",
            "fax_number": "253-236-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25223 146TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980423410",
            "telephone_number": "253-236-5352",
            "fax_number": "253-236-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-13",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "KHADKA",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "RESIDENT MANAGER",
        "authorized_official_telephone_number": "425-835-6512",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2139440",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pristine House",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pristine House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Kent, WA
• Providers in Kent, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.