Provider Demographics
NPI:1932651197
Name:US VETERAN'S INITIATIVE, LONG BEACH
Entity Type:Organization
Organization Name:US VETERAN'S INITIATIVE, LONG BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-487-5744
Mailing Address - Street 1:2001 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-3622
Mailing Address - Country:US
Mailing Address - Phone:562-200-7355
Mailing Address - Fax:
Practice Address - Street 1:2001 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-3622
Practice Address - Country:US
Practice Address - Phone:562-200-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US VETERAN'S INITIATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36631324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility