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General NPI Number Information
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NPI Number | 1730382060
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Entity Type | Organization
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Legal Business Name | US DEPT OF VETARNS AFFAIRS
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1206 CHAPLINE ST
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City | WHEELING
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State | WV
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Zip | 26003-3317
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Country | US
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Telephone | 304-232-0587
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Fax | 304-232-1031
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Provider Business Mailing Address
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Address Line | 1206 CHAPLINE ST
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City | WHEELING
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State | WV
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Zip | 26003-3317
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Country | US
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Telephone | 304-232-0587
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Fax | 304-232-1031
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Authorized Official
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Title or Position | SUPERVISING SOCIAL WORKER
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Name | MR. JOHN WILLIAM LOONEY
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Credential | MSW
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Telephone | 304-232-0587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | DP00454754
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License Number State | WV
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