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1730128174 NPI number — CRESTWOOD BEHAVIORAL HEALTH, INC.

NPI Number: 1730128174
Health Care Provider/Practitioner: CRESTWOOD BEHAVIORAL HEALTH, INC.

Information about “1730128174” NPI (CRESTWOOD BEHAVIORAL HEALTH, INC.) exists in 1730128174 in HTML format HTML  |  1730128174 in plain Text format TXT  |  1730128174 in PDF (Portable Document Format) PDF  |  1730128174 in an XML format XML  formats.

NPI Number : 1730128174 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730128174",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CRESTWOOD BEHAVIORAL HEALTH, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7590 SHORELINE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STOCKTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95219-5455",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-955-2328",
    "MailingAddressFaxNumber": "209-952-5314",
    "FirstLinePracticeLocationAddress": "1130 MONACO CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STOCKTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95207-6704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-478-2060",
    "PracticeLocationAddressFaxNumber": "209-478-3175",
    "EnumerationDate": "06/04/2006",
    "LastUpdateDate": "05/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SMITH",
    "AuthorizedOfficialFirstName": "MICHELLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR REIMBURSEMENT",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "209-955-2364",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "314000000X",
        "TaxonomyName": "Skilled Nursing Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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