ZZ-STATE STREET VA CLINIC (3540) INSTITUTION (4)

Name	Value
NAME	ZZ-STATE STREET VA CLINIC
STATE	OHIO
STREET ADDR. 1	54 SOUTH STATE STREET, #204
CITY	PAINESVILLE
ZIP	44077-3445
OFFICIAL VA NAME	STATE STREET VA CLINIC
INACTIVE FACILITY FLAG	INACTIVE
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 10 PARENT FACILITY PARENT OF ASSOCIATION: CLEVELAND VAMC
BILLING FACILITY NAME	LAKE COUNTY VA CBOC
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1215344270 2018-11-14 00:00:00 STATUS: INACTIVE NPI: 1215344270
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	EASTERN
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	541GN