Provider Demographics
NPI:1548393929
Name:OLIVE CREST
Entity Type:Organization
Organization Name:OLIVE CREST
Other - Org Name:CYS OLIVE CREST WRAPAROUND
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERLEUR
Authorized Official - Suffix:II
Authorized Official - Credentials:MBA
Authorized Official - Phone:714-543-5437
Mailing Address - Street 1:2130 E 4TH ST.
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-543-5437
Mailing Address - Fax:714-543-5463
Practice Address - Street 1:2130 E 4TH ST.
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-543-5437
Practice Address - Fax:714-543-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30AUMedicaid