Provider Demographics
NPI:1447758024
Name:CRESTWOOD BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:CRESTWOOD BEHAVIORAL HEALTH INC
Other - Org Name:SAN FRANCISCO HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIT/REIMBURSEMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-955-2328
Mailing Address - Street 1:7590 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-5455
Mailing Address - Country:US
Mailing Address - Phone:209-955-2328
Mailing Address - Fax:209-644-5721
Practice Address - Street 1:450 STANYAN ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1019
Practice Address - Country:US
Practice Address - Phone:209-955-2328
Practice Address - Fax:209-644-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness