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General NPI Number Information
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NPI Number | 1497810188
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 12/25/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | HC 61 BOX 2029 260 CANDY KITCHEN RD
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City | RAMAH
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State | NM
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Zip | 87321-9608
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Country | US
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Telephone | 505-775-3276
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Fax |
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Provider Business Mailing Address
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Address Line | HC 61 BOX 2029 260 CANDY KITCHEN RD
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City | RAMAH
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State | NM
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Zip | 87321-9608
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Country | US
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Telephone | 505-775-3276
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Fax |
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Authorized Official
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Title or Position | TOUR SUPERVISOR
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Name | MR. SHIRLEY ELAINE ROPER
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Credential | R.N.
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Telephone | 505-265-1711
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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 | R48833
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License Number State | NM
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