Provider Demographics
NPI:1780009142
Name:CRESTWOOD BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:CRESTWOOD BEHAVIORAL HEALTH, INC.
Other - Org Name:CRESTWOOD PSYCHIATRIC HEALTH FACILITY SOLANO
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:209-478-5291
Mailing Address - Fax:209-952-5314
Practice Address - Street 1:2201 TUOLUMNE ST STE B
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2524
Practice Address - Country:US
Practice Address - Phone:707-558-1777
Practice Address - Fax:707-558-1770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESTWOOD BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital