Provider Demographics
NPI:1437354008
Name:PURVIS, DALE J (NHA)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:PURVIS
Suffix:
Gender:M
Credentials:NHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60179-0001
Mailing Address - Country:US
Mailing Address - Phone:847-286-2527
Mailing Address - Fax:847-286-4102
Practice Address - Street 1:3333 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60179-0001
Practice Address - Country:US
Practice Address - Phone:847-286-2527
Practice Address - Fax:847-286-4102
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4079376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator