Provider Demographics
NPI:1730382060
Name:US DEPT OF VETARNS AFFAIRS
Entity type:Organization
Organization Name:US DEPT OF VETARNS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:304-232-0587
Mailing Address - Street 1:1206 CHAPLINE ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3317
Mailing Address - Country:US
Mailing Address - Phone:304-232-0587
Mailing Address - Fax:304-232-1031
Practice Address - Street 1:1206 CHAPLINE ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3317
Practice Address - Country:US
Practice Address - Phone:304-232-0587
Practice Address - Fax:304-232-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00454754283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDP00454754OtherLICSW
WV10505OtherBCD