Provider Demographics
NPI:1124336268
Name:FLORIDA DEPARTMENT OF VETERANS' AFFAIRS
Entity type:Organization
Organization Name:FLORIDA DEPARTMENT OF VETERANS' AFFAIRS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, FDVA
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-518-3203
Mailing Address - Street 1:4650 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-0600
Mailing Address - Country:US
Mailing Address - Phone:904-940-2193
Mailing Address - Fax:
Practice Address - Street 1:4650 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-0600
Practice Address - Country:US
Practice Address - Phone:904-940-2193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility