=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679846604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAHS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2012
-----------------------------------------------------
Last Update Date | 02/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 FULLER RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-769-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215 FULLER RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-769-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN
-----------------------------------------------------
Name | ERICA JINERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-845-3695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 4704211802
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------