Name | Value |
---|---|
PROVIDER TYPE | Other Service |
CLASSIFICATION | Nursing Home Administrator |
STATUS | Inactive |
DATE INACTIVATED | 1998-10-20 00:00:00 |
VA CODE | V081200 |
reserved | P674 |
INDIVIDUAL/NON | INDIVIDUAL |
MASTER ENTRY FOR VUID | YES |
VUID | 5253125 |
EFFECTIVE DATE/TIME |
|