Healthcare Provider Details

I. General information

NPI: 1053238329
Provider Name (Legal Business Name): CRIMSON'S RECOVERY, BEHAVIORAL HEALTH AND OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 W 51ST ST
LOS ANGELES CA
90062-2224
US

IV. Provider business mailing address

15345 FAIRFIELD RANCH RD STE 260
CHINO HILLS CA
91709-8838
US

V. Phone/Fax

Practice location:
  • Phone: 840-228-7740
  • Fax:
Mailing address:
  • Phone: 840-228-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACOB MCCOLLUM
Title or Position: CEO
Credential:
Phone: 840-228-7740