Provider Demographics
NPI:1982159778
Name:BEDFORD VA HOSPITAL
Entity Type:Organization
Organization Name:BEDFORD VA HOSPITAL
Other - Org Name:EDITH NOURSE ROGERS MEMORIAL VA HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF THE MENTAL HEALTH SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DREBING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-687-2462
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-2000
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005388284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital