Basic Information
| Provider Information | |||||||||
| NPI: | 1780790303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COATESVILLE VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 142 FEDERAL WALK | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193481867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107644800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 BLACKHORSE HILL RD | ||||||||
| Address2: | |||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193202040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103847711 | ||||||||
| FaxNumber: | 6109481464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 12/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | MASSEY | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRIMARY CARE SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 6105433246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | CW014903 | PA | Y | Hospitals | Psychiatric Hospital |
No ID Information.