Provider Demographics
NPI: | 1013261874 |
---|---|
Name: | DEPARTMENT OF VETERANS AFFAIRS CENTRAL IOWA HEALTH CARE SYSTEM |
Entity Type: | Organization |
Organization Name: | DEPARTMENT OF VETERANS AFFAIRS CENTRAL IOWA HEALTH CARE SYSTEM |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REGISTERED NURSE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WHITNEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 515-779-4517 |
Mailing Address - Street 1: | 3011 AURORA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DES MOINES |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50310 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 515-779-4517 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3011 AURORA AVE |
Practice Address - Street 2: | |
Practice Address - City: | DES MOINES |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50310 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-779-4517 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-11-01 |
Last Update Date: | 2012-11-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 128016 | 282E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 282E00000X | Hospitals | Long Term Care Hospital |