Healthcare Provider Details

I. General information

NPI: 1770839540
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 W SHAW BUTTE DR
PHOENIX AZ
85029-3434
US

IV. Provider business mailing address

2349 W SHAW BUTTE DR
PHOENIX AZ
85029-3434
US

V. Phone/Fax

Practice location:
  • Phone: 602-435-6384
  • Fax:
Mailing address:
  • Phone: 602-435-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLP045618
License Number StateAZ

VIII. Authorized Official

Name: GARY HANKINS
Title or Position: MEDICAL STAFF SPECIALIST
Credential:
Phone: 602-277-5551