Provider Demographics
NPI:1801909254
Name:CINICINNAT VETERANS ADMINISTRATION
Entity type:Organization
Organization Name:CINICINNAT VETERANS ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECREATION THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHANNAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:859-572-6218
Mailing Address - Street 1:1040 BELLPOINTE COMMONS
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1548
Mailing Address - Country:US
Mailing Address - Phone:859-291-8267
Mailing Address - Fax:
Practice Address - Street 1:1040 BELLPOINTE COMMONS
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1548
Practice Address - Country:US
Practice Address - Phone:859-291-8267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty