NPIMap

Organization Active NPI

Pristine Residential Care

  • Home Health Agency
  • Toledo, OH
National Provider Identifier
1699499798
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PRISTINE RESIDENTIAL CARE
Practice address
709 Lodge Ave
Toledo, OH 43609-2915
Phone
(567) 702-1078
NPI assigned
Oct 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Demetria ClarkNPI 1487209722
Title
Ceo
Phone
(567) 702-1078

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Home Health Agency 251E00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
Secured Medical Transport (VAN) 343800000X
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

709 Lodge Ave
Toledo, OH 43609-2915

Mailing address

709 Lodge Ave
Toledo, OH 43609-2915
Phone (567) 702-1078

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1699499798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 LODGE AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436092915",
            "telephone_number": "567-702-1078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 LODGE AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436092915",
            "telephone_number": "567-702-1078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-02",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DEMETRIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "567-702-1078"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343800000X",
            "taxonomy_group": "",
            "desc": "Secured Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.