Provider Demographics
NPI:1134106131
Name:VILSECK MEDICAL TREATMENT FACILITY
Entity Type:Organization
Organization Name:VILSECK MEDICAL TREATMENT FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:011-499-3180
Mailing Address - Street 1:CMR 411, BOX 549
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:DE
Mailing Address - Phone:0114-996-6283
Mailing Address - Fax:3143
Practice Address - Street 1:CMR 411, BOX 549
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:0114-996-6283
Practice Address - Fax:3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW111104273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASW111104OtherSOCIAL WORKER