CRESTWOOD BEHAVIORAL HEALTH, INC. (CRESTWOOD HOPE CENTER) - NPI NUMBER 1962702324
Provider Name: CRESTWOOD BEHAVIORAL HEALTH, INC. (CRESTWOOD HOPE CENTER)
NPI Number: 1962702324
Clasification: Community Based Residential Treatment Facility, Mental Illness (320800000X)
115 ODDSTAD DR
Phone Number: (707) 552-0215
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
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
||CRESTWOOD BEHAVIORAL HEALTH, INC.
Community Based Residential Treatment Facility, Mental Illness
The following information regarding the scope of practice of this provider is available:
||Community Based Residential Treatment Facility, Mental Illness
||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.
||Entity Type Code
||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).
||Employer Identification Number EIN
||The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
||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.
||Provider Other Organization Name
||CRESTWOOD HOPE CENTER
||Other name by which the organization provider is or has been known.
||Provider Other Organization Name Type Code
||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.
||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.
||Provider Business Practice Location Address City Name
||The city name in the location address of the provider being identified.
||Provider Business Practice Location Address State Name
||The State code in the location of the provider
||Provider Business Practice Location Address Postal Code
||The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
||Provider Business Practice Location Address Country Code If outside U S
||The country code in the location address of the provider being identified.
||Provider Business Practice Location Address Telephone Number
||The telephone number associated with the location address of the provider being identified.
||Provider Business Practice Location Address Fax Number
||The fax number associated with the location
address of the provider being identified.
||Provider Enumeration Date
||The date the provider was assigned a unique identifier (assigned an NPI).
||Last Update Date
||The date that a record was last updated or changed.
||Authorized Official Last Name
||The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
||Authorized Official First Name
||The first name of the authorized official.
||Authorized Official Title or Position
||The title or position of the authorized official.
||Authorized Official Telephone Number
||The 10-position telephone number of the authorized official.
||Healthcare Provider Taxonomy Code 1
||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.
||Healthcare Provider Primary Taxonomy Switch 1
||Is Organization Subpart
||Authorized Official Name Prefix Text
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: 3/10/2015
(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
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.