Provider Demographics
NPI:1629771811
Name:CRESTWOOD BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:CRESTWOOD BEHAVIORAL HEALTH, INC.
Other - Org Name:CRESTWOOD SAN LUIS OBISPO PSYCHIATRIC HEALTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AR AND REIMB.
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-955-2364
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:209-955-2339
Mailing Address - Fax:209-671-1520
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:209-955-2364
Practice Address - Fax:209-671-1520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESTWOOD BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital