NPIMap

Organization Active NPI

Pristine Home Health Inc

  • Home Health Agency
  • Burbank, CA
National Provider Identifier
1780007096
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980001347 Issued in CA
Legal business name
PRISTINE HOME HEALTH INC
Practice address
1419 N San Fernando Blvd
Suite 100
Burbank, CA 91504-4141
Phone
(818) 582-4110
Fax
(818) 478-2306
NPI assigned
Jan 23, 2014
Last updated
Jul 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Authorized official

Name
Mary Gay Iren Tan
Title
Administrator
Phone
(818) 582-4110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980001347 CA Primary

Addresses

Primary practice location

1419 N San Fernando Blvd
Suite 100
Burbank, CA 91504-4141

Mailing address

1419 N San Fernando Blvd
Suite 100
Burbank, CA 91504-4141
Phone (818) 582-4110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140331001110 CA Part A Provider - Home Health Agency 2062643356 Practice locations: Burbank, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780007096. Details of each certification follow.

Home health agency certification: CCN 058128

Legal name
PRISTINE HOME HEALTH INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 20, 2002
Last certification
Oct 4, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationProprietary
Enrollment address
1419 N San Fernando Blvd
Ste 100
Burbank, CA 91504-4100

Care Compare: Home health agency

Medicare Care Compare
Listed as
Pristine Home Health IncCCN 058128 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Aug 20, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1002635Pristine Home Health, Inc1419 N San Fernando Blvd, #100, Burbank, CA 91504Certificate of waiverAug 11, 2026

National Provider Directory

National Provider Directory

Locations

30 E Santa Clara St
Arcadia, CA 91006
Phone (626) 447-2273

1419 N San Fernando Blvd
Ste 100
Burbank, CA 91504
Phone (818) 582-4110

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jess Moralde Individual Corporate OfficerCfo Jan 1, 2025
Mary Gay Iren Y Tan Individual 5% Or Greater Direct Ownership Interest Jan 31, 2014 100%
Corporate OfficerPresident Jan 31, 2014 100%
Corporate DirectorPresident Jan 31, 2014 100%
W-2 Managing EmployeeAdministrator Jan 31, 2014 100%

Practitioners & affiliated clinicians

Affiliated clinicians 15

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1780007096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 N SAN FERNANDO BLVD",
            "address_2": "SUITE 100",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915044141",
            "telephone_number": "818-582-4110",
            "fax_number": "818-478-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 N SAN FERNANDO BLVD",
            "address_2": "SUITE 100",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915044141",
            "telephone_number": "818-582-4110",
            "fax_number": "818-478-2306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE HOME HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-23",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "MARY GAY IREN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-582-4110"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.