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General NPI Number Information
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NPI Number | 1366811192
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Entity Type | Organization
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Legal Business Name | DEPT. OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 5000 S 5TH AVE
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City | HINES
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State | IL
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Zip | 60141-3030
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Country | US
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Telephone | 708-202-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 10910 BEAR ISLAND AVE
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City | ORLAND PARK
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State | IL
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Zip | 60467-5398
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Country | US
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Telephone | 708-403-2159
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Fax |
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Authorized Official
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Title or Position | SCI CO-ORDINATOR
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Name | MRS. AMMAL VARGHESE
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Credential | NP
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Telephone | 708-202-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 209.011416
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License Number State | IL
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