Healthcare Provider Details

I. General information

NPI: 1992053631
Provider Name (Legal Business Name): CRESTWOOD BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 AZTEC LN
LATHROP CA
95330-9142
US

IV. Provider business mailing address

482 AZTEC LN
LATHROP CA
95330-9142
US

V. Phone/Fax

Practice location:
  • Phone: 209-922-9902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLP36472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLP36472
License Number StateCA

VIII. Authorized Official

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