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General NPI Number Information
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NPI Number | 1285985770
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Entity Type | Organization
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Legal Business Name | VETERANS ADMINISTRATION
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 820 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3728
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Country | US
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Telephone | 312-560-7907
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Fax |
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Provider Business Mailing Address
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Address Line | 2657 W 59TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2139
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Country | US
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Telephone | 773-671-5111
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Fax |
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Authorized Official
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Title or Position | SUPERVISORY SOCIAL WORK
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Name | JAMES MITCHELL
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Credential | LCSW
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Telephone | 773-569-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 54132
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License Number State | TX
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