Healthcare Provider Details

I. General information

NPI: 1295146934
Provider Name (Legal Business Name): CRESTWOOD BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 UNIVERSITY AVE STE A
SAN DIEGO CA
92105
US

IV. Provider business mailing address

520 CAPITOL MALL STE 800
SACRAMENTO CA
95814-4716
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-5291
  • Fax:
Mailing address:
  • Phone: 209-478-5291
  • Fax: 209-644-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

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