Provider Demographics
NPI:1528517711
Name:RALPH H. JOHNSON VA MEDICAL CENTER
Entity type:Organization
Organization Name:RALPH H. JOHNSON VA MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STREAKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:843-789-7393
Mailing Address - Street 1:8531 SENTRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420
Mailing Address - Country:US
Mailing Address - Phone:843-864-1554
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401
Practice Address - Country:US
Practice Address - Phone:843-789-7393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11769286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital