Provider Demographics
NPI:1588752885
Name:VETERANS ADMINISTRATION
Entity type:Organization
Organization Name:VETERANS ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, VAMHCS, MEDICAL STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:JJ
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM, CPCS
Authorized Official - Phone:410-605-7347
Mailing Address - Street 1:3 BRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOPPATOWNE
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4507
Mailing Address - Country:US
Mailing Address - Phone:410-679-5275
Mailing Address - Fax:
Practice Address - Street 1:1-H CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility