Provider Demographics
NPI:1093142002
Name:CT VA HEALTHCARE
Entity Type:Organization
Organization Name:CT VA HEALTHCARE
Other - Org Name:DEPT. OF VETERAN'S AFFAIR'S
Other - Org Type:Other Name
Authorized Official - Title/Position:APRN, MSN IN PRIMARY CARE CLINIC
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, MSN
Authorized Official - Phone:203-932-5711
Mailing Address - Street 1:950 CAMPBELL AVE
Mailing Address - Street 2:CENTER OF EXCELLENCE IN PRIMARY CARE (COE)
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:CENTER OF EXCELLENCE IN PRIMARY CARE ( COE)
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005491282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital