Provider Demographics
NPI:1194744094
Name:DAYTON VA MEDICAL CENTER
Entity type:Organization
Organization Name:DAYTON VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTREACH SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:937-268-6511
Mailing Address - Street 1:82 ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
MI6801081048284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered284300000XHospitalsSpecial Hospital