Provider Demographics
NPI:1134679103
Name:THE BOARD OF TRUSTEES OF THE LELAND STANFORD JUNIOR UNIVERSITY
Entity Type:Organization
Organization Name:THE BOARD OF TRUSTEES OF THE LELAND STANFORD JUNIOR UNIVERSITY
Other - Org Name:VADEN HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-725-1366
Mailing Address - Street 1:866 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-8508
Mailing Address - Country:US
Mailing Address - Phone:650-725-1366
Mailing Address - Fax:650-723-4999
Practice Address - Street 1:866 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-8508
Practice Address - Country:US
Practice Address - Phone:650-725-1366
Practice Address - Fax:650-723-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)