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General NPI Number Information
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NPI Number | 1740580828
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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 | 10/23/2010
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Last Update Date | 10/23/2010
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Provider Practice Location Address
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Address Line | 23809 E SILSBY RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-1271
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Country | US
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Telephone | 216-291-9542
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Fax |
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Provider Business Mailing Address
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Address Line | 23809 E SILSBY RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-1271
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Country | US
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Telephone | 216-291-9542
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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 | MISS CHRISTA ANN POOLE
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Credential | LISW-S
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Telephone | 216-956-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | I0700155
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License Number State | OH
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