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General NPI Number Information
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NPI Number | 1962702324
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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 | 11/01/2010
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 115 ODDSTAD DR
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City | VALLEJO
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State | CA
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Zip | 94589-2520
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Country | US
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Telephone | 707-552-0215
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Fax | 707-553-2161
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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 | 209-952-5314
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR REIMBURSEMENT
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Name | MRS. 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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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