Provider Demographics
NPI:1407449176
Name:WHITE, DALE A (DSP, CRMA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:DSP, CRMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 TATE RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:ME
Mailing Address - Zip Code:04427-3609
Mailing Address - Country:US
Mailing Address - Phone:207-924-4113
Mailing Address - Fax:
Practice Address - Street 1:414 TATE RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427-3609
Practice Address - Country:US
Practice Address - Phone:207-924-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility