CRESTWOOD BEHAVIORAL HEALTH, INC. (CRESTWOOD HOPE CENTER) - NPI NUMBER 1962702324

Summary

Provider Name: CRESTWOOD BEHAVIORAL HEALTH, INC. (CRESTWOOD HOPE CENTER)

NPI Number: 1962702324

Clasification: Community Based Residential Treatment Facility, Mental Illness (320800000X)

Address:
115 ODDSTAD DR
VALLEJO, CA
ZIP 94589

Phone Number: (707) 552-0215



Detailed Information

CRESTWOOD BEHAVIORAL HEALTH, INC. is a community based residential treatment facility, mental illness in Vallejo, CA. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. The assigned NPI number for this provider is 1962702324 and is registered as an organization entity type.
The provider Is Doing Business As Crestwood Hope Center.

The provider's business address is:

115 ODDSTAD DR
VALLEJO, CA
ZIP 94589-520
Phone: (707) 552-0215
Fax: (707) 553-2161

The provider's authorized official is Lori Blackburn .
The authorized official title is Vice President and has the following contact phone number (209) 955-2322.

The enumeration date for this NPI number is 11/1/2010 and was last updated on 11/1/2010.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1750452199 CRESTWOOD BEHAVIORAL HEALTH, INC.
Community Based Residential Treatment Facility, Mental Illness

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 320800000X Community Based Residential Treatment Facility, Mental Illness Yes

NPI Record

No. Field Name Field Value
1 NPI 1962702324
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CRESTWOOD BEHAVIORAL HEALTH, INC.
5 Provider Other Organization Name CRESTWOOD HOPE CENTER
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 115 ODDSTAD DR
8 Provider Business Practice Location Address City Name VALLEJO
9 Provider Business Practice Location Address State Name CA
10 Provider Business Practice Location Address Postal Code 945892520
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 7075520215
13 Provider Business Practice Location Address Fax Number 7075532161
14 Provider Enumeration Date 11/1/2010
15 Last Update Date 11/1/2010
16 Authorized Official Last Name BLACKBURN
17 Authorized Official First Name LORI
18 Authorized Official Title or Position VICE PRESIDENT
19 Authorized Official Telephone Number 2099552322
20 Healthcare Provider Taxonomy Code 1 320800000X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text MRS.

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.