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General NPI Number Information
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NPI Number | 1992823850
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Entity Type | Organization
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Legal Business Name | OLIVE CREST TREATMENT CTR.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 710 S VICTORY BLVD SUITE 201
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City | BURBANK
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State | CA
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Zip | 91502-2425
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Country | US
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Telephone | 818-563-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 E 4TH ST SUITE 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 | 714-543-5437
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DONALD A. VERLEUR
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Credential | MA
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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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