Basic Information
| Provider Information | |||||||||
| NPI: | 1679843981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA ANN ARBOR HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 FULLER RD | ||||||||
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| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481052303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347697100 | ||||||||
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| Address1: | 2215 FULLER RD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481052303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347697100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2012 | ||||||||
| LastUpdateDate: | 08/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | AMAYA | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF, HIOT/SUD IOP | ||||||||
| AuthorizedOfficialTelephone: | 7348453023 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW, ACSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 4704286155 | MI | Y | Hospitals | General Acute Care Hospital |
No ID Information.