Provider Demographics
NPI:1558315127
Name:JAMES A. HALEY VETERANS HOSPITAL
Entity Type:Organization
Organization Name:JAMES A. HALEY VETERANS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDTP PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-631-7126
Mailing Address - Street 1:10406 N 62ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3702
Mailing Address - Country:US
Mailing Address - Phone:813-631-7126
Mailing Address - Fax:813-631-7128
Practice Address - Street 1:11707 CLUB DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5521
Practice Address - Country:US
Practice Address - Phone:813-631-7135
Practice Address - Fax:813-631-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility