Healthcare Provider Details

I. General information

NPI: 1124211156
Provider Name (Legal Business Name): VETERAN'S ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

6375 MARBURY CT
HUBER HEIGHTS OH
45424-3671
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax:
Mailing address:
  • Phone: 937-237-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number015284
License Number StatePR

VIII. Authorized Official

Name: MS. NEREIDA C SANTIAGO
Title or Position: WOUND AND SKIN NURSE
Credential: RN
Phone: 937-268-6511