Provider Demographics
NPI:1609982289
Name:PHILADELPHIA VETERANS AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:PHILADELPHIA VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:BEHAVIORAL HEALTH OPT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH SCIENCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-823-5809
Mailing Address - Street 1:3900 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4551
Mailing Address - Country:US
Mailing Address - Phone:215-823-5809
Mailing Address - Fax:215-823-4584
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5809
Practice Address - Fax:215-823-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)