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General NPI Number Information
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NPI Number | 1639547912
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Entity Type | Organization
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Legal Business Name | US DEPT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 500 N US HIGHWAY 89
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City | PRESCOTT
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State | AZ
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Zip | 86313-5001
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Country | US
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Telephone | 928-445-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N US HIGHWAY 89
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City | PRESCOTT
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State | AZ
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Zip | 86313-5001
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Country | US
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Telephone | 928-445-4860
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. JANICE ELIZABETH THRON-KELLY
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Credential | LSW
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Telephone | 928-445-4860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | SW 011786L
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License Number State | PA
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