Provider Demographics
NPI:1114197639
Name:CRESTWOOD HEALING CENTER
Entity Type:Organization
Organization Name:CRESTWOOD HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECORDS
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:GUNTHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-938-8050
Mailing Address - Street 1:550 PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4155
Mailing Address - Country:US
Mailing Address - Phone:925-938-8050
Mailing Address - Fax:
Practice Address - Street 1:550 PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4155
Practice Address - Country:US
Practice Address - Phone:925-938-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility