Provider Demographics
NPI:1508263369
Name:BOSTON VA HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:BOSTON VA HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-826-1257
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:BOSTON HEALTHCARE SYSTEM
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:774-826-1257
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:BOSTON HEALTHCARE SYSTEM
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-1257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAA273Y00000X, 286500000X, 2865M2000X, 2865X1600X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No273Y00000XHospital UnitsRehabilitation Unit
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility