Provider Demographics
NPI:1114975513
Name:WEED ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:WEED ARMY COMMUNITY HOSPITAL
Other - Org Name:MEDDAC FORT IRWIN, CA
Other - Org Type:Other Name
Authorized Official - Title/Position:HEAD NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-380-5183
Mailing Address - Street 1:15752 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5046
Mailing Address - Country:US
Mailing Address - Phone:951-235-6329
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 170
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-5183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481436286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA481436OtherREGISTERED NURSE