Provider Demographics
NPI:1154748812
Name:PRISTINE HOSPICE CARE PLUS
Entity type:Organization
Organization Name:PRISTINE HOSPICE CARE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-824-5099
Mailing Address - Street 1:13146 MUNGO CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9157
Mailing Address - Country:US
Mailing Address - Phone:562-824-5099
Mailing Address - Fax:
Practice Address - Street 1:13146 MUNGO CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9157
Practice Address - Country:US
Practice Address - Phone:562-824-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based