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General NPI Number Information
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NPI Number | 1508491697
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Entity Type | Organization
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Legal Business Name | OLIVE CREST
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 3516 S 47TH ST STE 203
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City | TACOMA
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State | WA
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Zip | 98409-4475
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Country | US
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Telephone | 253-572-7888
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Fax | 253-572-7727
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Provider Business Mailing Address
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Address Line | 2130 E 4TH ST STE 200
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City | SANTA ANA
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State | CA
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Zip | 92705-3818
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Country | US
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Telephone | 714-856-7177
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DONALD VERLEUR
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Credential | MBA
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Telephone | 714-543-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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