Provider Demographics
NPI:1114030210
Name:VETERANS AFFAIRS
Entity Type:Organization
Organization Name:VETERANS AFFAIRS
Other - Org Name:VA HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADDICTION THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WITBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-440-1000
Mailing Address - Street 1:1281 SE MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4372
Mailing Address - Country:US
Mailing Address - Phone:541-440-1000
Mailing Address - Fax:
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:WARD 2, BLDG 2, SARTP
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6523
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit