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General NPI Number Information
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NPI Number | 1124046008
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Entity Type | Organization
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Legal Business Name | CRESTWOOD BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 2370 BUHNE ST
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City | EUREKA
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State | CA
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Zip | 95501-3237
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Country | US
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Telephone | 707-442-5721
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Fax | 707-442-4812
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Provider Business Mailing Address
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Address Line | 7590 SHORELINE DR
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City | STOCKTON
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State | CA
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Zip | 95219-5455
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Country | US
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Telephone | 209-955-2328
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Fax | 209-478-3717
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR AR AND REIMB.
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Name | MICHELLE SMITH
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Credential |
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Telephone | 209-955-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 0216013
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License Number State | CA
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