Provider Demographics
NPI:1184441446
Name:PRISTINE ENDEAVOR LLC
Entity type:Organization
Organization Name:PRISTINE ENDEAVOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SITAULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-860-5760
Mailing Address - Street 1:150 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1417
Mailing Address - Country:US
Mailing Address - Phone:603-860-5760
Mailing Address - Fax:
Practice Address - Street 1:150 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1417
Practice Address - Country:US
Practice Address - Phone:603-860-5760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities