Provider Demographics
NPI:1467045138
Name:UNITED STATES VETERANS INITIATIVE
Entity Type:Organization
Organization Name:UNITED STATES VETERANS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-382-7556
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-1410
Mailing Address - Country:US
Mailing Address - Phone:310-382-7556
Mailing Address - Fax:310-455-1416
Practice Address - Street 1:91-1010 SHANGRILA ST STE 103104
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2161
Practice Address - Country:US
Practice Address - Phone:808-271-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED STATES VETERANS INITIATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty