1407147077 NPI number — DEPARTMENT OF VETERANS AFFAIRS VA ANN ARBOR HEALTHCARE SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407147077 NPI number — DEPARTMENT OF VETERANS AFFAIRS VA ANN ARBOR HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF VETERANS AFFAIRS VA ANN ARBOR HEALTHCARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407147077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 GLENDALE AVE TOLEDO OHIO 43614
Provider Second Line Business Mailing Address:
HCHV PROGRAM VA TOLEDO CBOC
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-213-7663
Provider Business Mailing Address Fax Number:
419-724-4149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 GLENDALE AVE., TOLEDO OHIO 43614
Provider Second Line Business Practice Location Address:
HCHV PROGRAM VA TOLEDO CBOC
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-213-7663
Provider Business Practice Location Address Fax Number:
419-724-4149
Provider Enumeration Date:
04/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NOVITSKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
OUTREACH SOCIAL WORKER
Authorized Official Telephone Number:
419-213-7663

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I0009959 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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