Provider Demographics
NPI:1770839482
Name:VA HOSPITAL - LONG BEACH
Entity Type:Organization
Organization Name:VA HOSPITAL - LONG BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:VANDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMSW, LCAC
Authorized Official - Phone:562-826-8470
Mailing Address - Street 1:5901 EAST 7TH ST.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:562-826-8485
Practice Address - Street 1:2090 RIVER AVENUE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810
Practice Address - Country:US
Practice Address - Phone:562-826-8470
Practice Address - Fax:562-826-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital