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Organization
PRISTINE RESIDENTIAL CARE
Active
Organization
PRISTINE RESIDENTIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIA CLARK (CEO)
(567) 702-1078
Entity
Organization
Contact information
Practice address
709 LODGE AVE, TOLEDO, OH 43609-2915
(567) 702-1078
Mailing address
709 LODGE AVE, TOLEDO, OH 43609-2915
(567) 702-1078
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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