Healthcare Provider Details

I. General information

NPI: 1689990202
Provider Name (Legal Business Name): OLIVE CREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39820 PORTOLA AVE
PALM DESERT CA
92260-0622
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 951-686-8500
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DONALD VERLEUR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 714-543-5437