Provider Demographics
NPI:1225383961
Name:BOSTON VA HOSPITAL
Entity Type:Organization
Organization Name:BOSTON VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REZENDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-826-3212
Mailing Address - Street 1:92 FRIENDLY RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-1218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT STREET
Practice Address - Street 2:BOSTON VA HEALTHCARE SYSTEM
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01043282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital