Provider Demographics
NPI:1992823850
Name:OLIVE CREST TREATMENT CTR.
Entity Type:Organization
Organization Name:OLIVE CREST TREATMENT CTR.
Other - Org Name:ADOPTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERLEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-543-5437
Mailing Address - Street 1:2130 E 4TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3818
Mailing Address - Country:US
Mailing Address - Phone:714-543-5437
Mailing Address - Fax:
Practice Address - Street 1:710 S VICTORY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2425
Practice Address - Country:US
Practice Address - Phone:818-563-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7534AMedicaid