Provider Demographics
NPI:1790580611
Name:UNITED STATES VETERANS INITIATIVE
Entity type:Organization
Organization Name:UNITED STATES VETERANS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CVHI SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACKSON ZENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-760-4630
Mailing Address - Street 1:800 W 6TH ST STE 1505
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2742
Mailing Address - Country:US
Mailing Address - Phone:213-760-4630
Mailing Address - Fax:
Practice Address - Street 1:1231 WARNER AVE STE 206
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6432
Practice Address - Country:US
Practice Address - Phone:213-760-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED STATES VETERANS INITIATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management