Provider Demographics
NPI:1467600296
Name:DEPARTMENT OF VETRANS AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETRANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARAMICST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:SUPERVISOR
Authorized Official - Phone:843-745-8637
Mailing Address - Street 1:5600 DORCHESTER RD APT 1406
Mailing Address - Street 2:POBOX 70103
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5517
Mailing Address - Country:US
Mailing Address - Phone:843-864-9124
Mailing Address - Fax:843-747-6841
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:3625 RIVERS AVE SUITE2
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-745-8637
Practice Address - Fax:843-747-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization