Pristine Senior Living of Portsmouth, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PRISTINE SENIOR LIVING OF PORTSMOUTH, LLC

Practice address

727 8TH St
Portsmouth, OH 45662-4020

Phone

(740) 354-8150

NPI assigned

Jul 21, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Christopher T Cook

Title

Chief Executive Officer

Phone

(317) 408-8491

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1518342492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W PURDUE AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473046356",
            "telephone_number": "317-408-8491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 8TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456624020",
            "telephone_number": "740-354-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE SENIOR LIVING OF PORTSMOUTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-21",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "317-408-8491",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2440915",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; 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.