Healthcare Provider Details

I. General information

NPI: 1790640514
Provider Name (Legal Business Name): CRESTWOOD BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 S WATNEY WAY
FAIRFIELD CA
94533-6757
US

IV. Provider business mailing address

2261 S WATNEY WAY
FAIRFIELD CA
94533-6757
US

V. Phone/Fax

Practice location:
  • Phone: 209-955-2316
  • Fax: 209-671-1520
Mailing address:
  • Phone: 209-955-2316
  • Fax: 209-671-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SMITH
Title or Position: EXECUTIVE DIRECTOR REIMBURSEMENT
Credential:
Phone: 209-955-2364