Healthcare Provider Details

I. General information

NPI: 1528093697
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER, VA LONG BEACH HEALTHCAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST SCI, BUILDING 150, ROOM T-236
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST SCI, BUILDING 150, ROOM T-236
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5718
Mailing address:
  • Phone: 562-826-8000
  • Fax: 562-826-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number992011
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number992011
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number992011
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number992011
License Number StateCO

VIII. Authorized Official

Name: MRS. PENNY R TIMMEN
Title or Position: LINCENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 562-826-8000