Basic Information
| Provider Information | |||||||||
| NPI: | 1457483398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DORN VETERANS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3509 LAKE AVE. APT. 2132 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29206 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3509 LAKE AVE APT 2132 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292065111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | MUSTARD | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF NURSE | ||||||||
| AuthorizedOfficialTelephone: | 8037764000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 106197 | SC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.