Provider Demographics
NPI:1528093697
Name:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER, VA LONG BEACH HEALTHCAR
Entity type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER, VA LONG BEACH HEALTHCAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LINCENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-826-8000
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:SCI, BUILDING 150, ROOM T-236
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:562-826-5718
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:SCI, BUILDING 150, ROOM T-236
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:562-826-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992011261QR0401X, 261QV0200X, 273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Not Answered261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
Not Answered273Y00000XHospital UnitsRehabilitation Unit
Not Answered282N00000XHospitalsGeneral Acute Care Hospital