Healthcare Provider Details

I. General information

NPI: 1730128174
Provider Name (Legal Business Name): CRESTWOOD BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 MONACO CT
STOCKTON CA
95207-6704
US

IV. Provider business mailing address

7590 SHORELINE DR
STOCKTON CA
95219-5455
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-2060
  • Fax: 209-478-3175
Mailing address:
  • Phone: 209-955-2328
  • Fax: 209-952-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

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