Provider Demographics
NPI:1275735409
Name:VA HOSPITAL
Entity Type:Organization
Organization Name:VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE MHICM
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:ERICA
Authorized Official - Last Name:KEEZER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:570-655-5606
Mailing Address - Street 1:127 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1930
Mailing Address - Country:US
Mailing Address - Phone:570-655-5606
Mailing Address - Fax:
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0030
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital