# CLEVELAND VA CBOC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154337558
- **Authorized official:** AGNES E. DEEHR (LPN)
- **Authorized official phone:** (920) 693-5600

## Contact information

- **Practice address:** 1205 NORTH AVE, CLEVELAND, WI 53015-1413
- **Practice address phone:** (188) 469-6614
- **Mailing address:** 336 E JEFFERSON AVE, CLEVELAND, WI 53015-1530
- **Mailing address phone:** (920) 693-8478

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 8882-031 | WI | Yes |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 08/22/2020