Provider Demographics
NPI:1851381032
Name:DEPARTMENT OF VETERANS AFFAIRS SPOKANE VETERANS HOME
Entity type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS SPOKANE VETERANS HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-725-2512
Mailing Address - Street 1:222 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1394
Mailing Address - Country:US
Mailing Address - Phone:509-344-5795
Mailing Address - Fax:509-344-5795
Practice Address - Street 1:222 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1394
Practice Address - Country:US
Practice Address - Phone:509-344-5770
Practice Address - Fax:509-344-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4000121Medicaid
WA4000121Medicaid
WA505509Medicare Oscar/Certification