Organization
PRISTINE SENIOR LIVING OF FREMONT, 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
1865 COUNTRYSIDE DR, FREMONT, OH 43420-8748
(419) 334-2602
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
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2303055
—
OH
Enumeration date
07/20/2015
Last updated
07/20/2015
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