Provider Demographics
NPI:1881720456
Name:OLIVE CREST
Entity type:Organization
Organization Name:OLIVE CREST
Other - Org Name:
Other - Org Type:
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:SUITE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3818
Mailing Address - Country:US
Mailing Address - Phone:714-543-5434
Mailing Address - Fax:
Practice Address - Street 1:15235 CORNUTA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3907
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:562-866-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7269Medicaid