Provider Demographics
NPI:1508188541
Name:PURVIS'S RETREAT
Entity Type:Organization
Organization Name:PURVIS'S RETREAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PURVIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-495-8385
Mailing Address - Street 1:20 THOROUGHBRED CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3553
Mailing Address - Country:US
Mailing Address - Phone:856-495-8385
Mailing Address - Fax:
Practice Address - Street 1:20 THOROUGHBRED CT
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3553
Practice Address - Country:US
Practice Address - Phone:856-495-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty