Provider Demographics
NPI:1396836995
Name:CARL T. HAYDEN VETERANS AFFAIRS
Entity Type:Organization
Organization Name:CARL T. HAYDEN VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FACILITY
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-277-5551
Mailing Address - Street 1:10331 E TEAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-6180
Mailing Address - Country:US
Mailing Address - Phone:480-895-4049
Mailing Address - Fax:
Practice Address - Street 1:10331 E TEAKWOOD CT
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-6180
Practice Address - Country:US
Practice Address - Phone:480-895-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106979282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital