Provider Demographics
NPI:1902060825
Name:VETERANS HEALTHCARE ADMINISTRATION
Entity Type:Organization
Organization Name:VETERANS HEALTHCARE ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUYRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-523-5833
Mailing Address - Street 1:400 VETERANS AVE
Mailing Address - Street 2:11ECP HBPC
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:228-523-5313
Mailing Address - Fax:228-523-5731
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:11ECP HBPC
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5313
Practice Address - Fax:228-523-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC6007284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital