Provider Demographics
NPI:1407147077
Name:DEPARTMENT OF VETERANS AFFAIRS VA ANN ARBOR HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS VA ANN ARBOR HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTREACH SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:NOVITSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-213-7663
Mailing Address - Street 1:3333 GLENDALE AVE TOLEDO OHIO 43614
Mailing Address - Street 2:HCHV PROGRAM VA TOLEDO CBOC
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614
Mailing Address - Country:US
Mailing Address - Phone:419-213-7663
Mailing Address - Fax:419-724-4149
Practice Address - Street 1:3333 GLENDALE AVE., TOLEDO OHIO 43614
Practice Address - Street 2:HCHV PROGRAM VA TOLEDO CBOC
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-213-7663
Practice Address - Fax:419-724-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00099591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty