Provider Demographics
NPI:1134856420
Name:PULLER VETERANS CARE CENTER
Entity type:Organization
Organization Name:PULLER VETERANS CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:703-859-2343
Mailing Address - Street 1:6951 VINT HILL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187
Mailing Address - Country:US
Mailing Address - Phone:703-859-2343
Mailing Address - Fax:
Practice Address - Street 1:6951 VINT HILL PKWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187
Practice Address - Country:US
Practice Address - Phone:703-859-2343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility