Provider Demographics
NPI:1710372099
Name:DEPARTMENT OF VETERAN AFFIARS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERAN AFFIARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VOCATIONA REHABILITATION COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:JIMMIE
Authorized Official - Last Name:RAKESTRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-384-2000
Mailing Address - Street 1:5000 W NATIONAL AVE
Mailing Address - Street 2:BUILDING #7 ROOM 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:BUILDING #7 ROOM 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty