Basic Information
| Provider Information | |||||||||
| NPI: | 1740295534 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 WILLOW RD # 11NH | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504935000 | ||||||||
| FaxNumber: | 6506172616 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 WILLOW RD # 11NH | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504935000 | ||||||||
| FaxNumber: | 6506172616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 08/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | SALOM-BAIL | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
| AuthorizedOfficialMiddleName: | RETUTA | ||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISORY SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 6504935000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW, MSG | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | LCS 18306 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.