Healthcare Provider Details

I. General information

NPI: 1790791069
Provider Name (Legal Business Name): VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 NORTHBRIDGE AVE
WARWICK RI
02886-2824
US

IV. Provider business mailing address

132 NORTHBRIDGE AVE
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-733-9276
  • Fax:
Mailing address:
  • Phone: 401-733-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberCSW 00303
License Number StateRI

VIII. Authorized Official

Name: MR. DANIEL F SULLIVAN
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 0