Organization
PRISTINE SENIOR LIVING OF BEAVERCREEK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER T COOK (CHIEF EXECUTIVE OFFICER)
(317) 408-8491
Entity
Organization
Contact information
Practice address
3854 PARK OVERLOOK DR, BEAVERCREEK, OH 45431-5801
(937) 429-9655
Mailing address
3301 W PURDUE AVE, MUNCIE, IN 47304-6356
(317) 408-8491
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0063595
—
OH
Enumeration date
07/20/2015
Last updated
07/20/2015
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