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

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 Field Definition 1
1 NPI 1962702324 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name CRESTWOOD BEHAVIORAL HEALTH, INC. The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name CRESTWOOD HOPE CENTER Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 115 ODDSTAD DR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name VALLEJO The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 945892520 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 7075520215 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 7075532161 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 11/1/2010 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 11/1/2010 The date that a record was last updated or changed.
16 Authorized Official Last Name BLACKBURN The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name LORI The first name of the authorized official.
18 Authorized Official Title or Position VICE PRESIDENT The title or position of the authorized official.
19 Authorized Official Telephone Number 2099552322 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 320800000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text MRS.

Similar Providers Nearby

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


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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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