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NPI Code Detail

MEDICARE: CRESTWOOD BEHAVIORAL HEALTH, INC.

MEDICARE: CRESTWOOD BEHAVIORAL HEALTH, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1407780471
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTWOOD BEHAVIORAL HEALTH, INC.
Provider Business Mailing Address
First Line : 7590 SHORELINE DR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-5455
Country : US
Telephone Number : 209-955-2316
Fax Number :
Provider Business Practice Location Address
First Line : 2180 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4558
Country : US
Telephone Number : 209-955-2316
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR REIMBURSEMENT
Name : MICHELLE SMITH
Credential :
Telephone Number : 209-955-2364
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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