Healthcare Provider Details

I. General information

NPI: 1073761490
Provider Name (Legal Business Name): DEPARTMENT OF VETERAN'S AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 STATE ROUTE 170 SUITE A CALCUTTA/EAST LIVERPOOL CBOC VA OUTPATIENT CLINIC
CALCUTTA OH
43920
US

IV. Provider business mailing address

15655 STATE ROUTE 170 SUITE A CALCUTTA/EAST LIVERPOOL CBOC VA OUTPATIENT CLINIC
CALCUTTA OH
43920
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax: 330-386-6020
Mailing address:
  • Phone: 330-386-4303
  • Fax: 330-386-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number7493
License Number StateTN

VIII. Authorized Official

Name: MS. KATHLEEN COONEY
Title or Position: SOCIAL WORK SUPERVISOR
Credential: LISW-S
Phone: 419-625-7350