Provider Demographics
NPI:1477751766
Name:DEPARTMENT OF VETERANS AFFAIR
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-932-5711
Mailing Address - Street 1:202 MAIN ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4559
Mailing Address - Country:US
Mailing Address - Phone:203-745-5175
Mailing Address - Fax:
Practice Address - Street 1:202 MAIN ST
Practice Address - Street 2:UNIT 3D
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4558
Practice Address - Country:US
Practice Address - Phone:203-745-5175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0705072865X1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)