Provider Demographics
NPI:1255443909
Name:VA MEDICAL CENTER
Entity type:Organization
Organization Name:VA MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RECREATION THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BS
Authorized Official - Phone:202-745-8000
Mailing Address - Street 1:1200 S COURT HOUSE RD
Mailing Address - Street 2:508
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-6256
Mailing Address - Country:US
Mailing Address - Phone:703-627-1001
Mailing Address - Fax:
Practice Address - Street 1:1200 S COURT HOUSE RD
Practice Address - Street 2:508
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-6256
Practice Address - Country:US
Practice Address - Phone:703-627-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility