| NAME |
BENTON HARBOR VA CLINIC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
1275 MALL DR |
| CITY |
BENTON HARBOR |
| ZIP |
49022-2309 |
| OFFICIAL VA NAME |
BENTON HARBOR VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BENTON HARBOR VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1275 MALL DR |
| CITY (MAILING) |
BENTON HARBOR |
| STATE (MAILING) |
MICHIGAN |
| ZIP (MAILING) |
49022-2309 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1174576458
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
515GC |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 115 MAIN ST
- CITY (CHANGED FROM): BENTON HARBOR
- STATE (CHANGED FROM): MICHIGAN
- ZIP (CHANGED FROM): 49022-3663
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1174576458
-
- CODING SYSTEM: VASTANUM
- ID: 515GC
|
