Healthcare Provider Details

I. General information

NPI: 1316101322
Provider Name (Legal Business Name): OLIVE CREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TECHNOLOGY CT
RIVERSIDE CA
92507-2155
US

IV. Provider business mailing address

2130 E. 4TH STREET SUITE 200
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-8500
  • Fax: 951-369-3037
Mailing address:
  • Phone: 714-543-5437
  • Fax: 714-543-5463

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 II
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 714-543-5473