Healthcare Provider Details

I. General information

NPI: 1740295534
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD # 11NH DEPARTMENT OF VETERANS AFFAIRS
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD # 11NH DEPARTMENT OF VETERANS AFFAIRS
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-617-2616
Mailing address:
  • Phone: 650-493-5000
  • Fax: 650-617-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLCS 18306
License Number StateCA

VIII. Authorized Official

Name: SHIRLEY RETUTA SALOM-BAIL
Title or Position: SUPERVISORY SOCIAL WORKER
Credential: MSW, MSG
Phone: 650-493-5000