Healthcare Provider Details

I. General information

NPI: 1144390964
Provider Name (Legal Business Name): CRESTWOOD BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ODDSTAD DR
VALLEJO CA
94589-2520
US

IV. Provider business mailing address

115 ODDSTAD DR
VALLEJO CA
94589-2520
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-0215
  • Fax: 707-553-2161
Mailing address:
  • Phone: 707-552-0215
  • Fax: 707-553-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number110000044
License Number StateCA

VIII. Authorized Official

Name: MICHELLE SMITH
Title or Position: EXECUTIVE DIRECTOR AR AND REIMB.
Credential:
Phone: 209-955-2364