Provider Demographics
NPI:1285982959
Name:U.S. DEPARTMENT OF VETERANS AFFAIRS
Entity type:Organization
Organization Name:U.S. DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPECIALIST/
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-826-8000
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:BLDG 128 RM K133A MAIL CODE 116A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:818-302-3700
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:BLDG 128 RM K133A MAIL CODE 116A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:818-302-3700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. DEPARTMENT OF VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN5520601343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)