Provider Demographics
NPI:1922111673
Name:VA ROSEBURG HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:VA ROSEBURG HEALTHCARE SYSTEM
Other - Org Name:VA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REHABILITATION TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-440-1000
Mailing Address - Street 1:1433 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1433 SE MAIN
Practice Address - Street 2:
Practice Address - City:ROSBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4213
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:541-440-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management