Healthcare Provider Details

I. General information

NPI: 1043313034
Provider Name (Legal Business Name): VA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number06238
License Number StateCT

VIII. Authorized Official

Name: SUSAN HILL
Title or Position: CLINICAL COORDINATOR
Credential: CISW
Phone: 203-932-5711