Healthcare Provider Details

I. General information

NPI: 1992823850
Provider Name (Legal Business Name): OLIVE CREST TREATMENT CTR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S VICTORY BLVD SUITE 201
BURBANK CA
91502-2425
US

IV. Provider business mailing address

2130 E 4TH ST SUITE 200
SANTA ANA CA
92705-3818
US

V. Phone/Fax

Practice location:
  • Phone: 818-563-2300
  • Fax:
Mailing address:
  • Phone: 714-543-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD A. VERLEUR
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 714-543-5437