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

Table of content: (NPI 1407147077)

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)





Copyright © 2007-2024 www.npivalidator.com