CRESTWOOD BEHAVIORAL HEALTH, INC (NPI# 1376623256) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376623256 |
| Entity Type | Organization |
| Organization Name | CRESTWOOD BEHAVIORAL HEALTH, INC |
| Other Organization Name | CRESTWOOD BEHAVIORAL HEALTH CENTER |
| Practice Address |
1425 Fruitdale Ave San Jose CA 95128-3234 |
| Mailing Address |
7590 Shoreline Dr Stockton CA 95219-5455 |
| Practice Telephone | 4082751010 |
| Practice Fax Number | 4082751066 |
| Mailing Telephone | 2099552328 |
| Mailing Fax Number | 2099525314 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2019-03-26 |
| Authorized Official Name | MS. LORI BLACKBURN (CAO/TREASURER) |
| Authorized Official Telephone | 2099552322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310500000X | Intermediate Care Facility, Mental Illness | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Crestwood Behavioral Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447572557 | Crestwood Behavioral Health, Inc | Community Based Residential Treatment Facility, Mental Illness | 6744 Eucalyptus Drive, Bakersfield, CA 93306 | 2010-02-17 |
| 1255657490 | Crestwood Behavioral Health, Inc | Clinic/Center | 2370 Buhne St, Eureka, CA 95501-3237 | 2010-04-13 |
| Street Address |
1425 FRUITDALE AVE |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95128-3234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851916415 | Zekarias Eyassu | Licensed Psychiatric Technician | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2020-06-10 |
| 1467096099 | Limalyn Cortez Valera | Licensed Vocational Nurse | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2019-11-06 |
| 1598065047 | Crestwood Behavioral Health, Inc. | Psychiatric Hospital | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2010-11-01 |
| 1164555686 | Stanislaus County | Community/Behavioral Health | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2007-03-13 |
| 1609908276 | Neal H Jacobi | Psychiatry & Neurology | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2007-03-09 |
| 1942357645 | Robert D Daigle | Family Medicine | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2007-01-04 |
| 1720157050 | Crestwood Behavioral Health, Inc. | Assisted Living Facility | 1425 Fruitdale Ave, San Jose, CA 95128-3234 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982227138 | Ruth Larsen | Social Worker | 850 S. Bascom Avenue, Suite 280, San Jose, CA 95128 | 2020-05-22 |
| 1265067185 | Of Two Minds Psychotherapy | Marriage & Family Therapist | 190 S. Bascom Ave, Ste 130, San Jose, CA 95128 | 2020-03-11 |
| 1982244166 | Cindy Pantoja Escobar | Behavior Technician | 100 O'connor Drive, Suites 21, San Jose, CA 95128 | 2020-01-15 |
| 1104460591 | Katherine Alexandra Misogas | Pharmacist | 777 Turner Dr # 330, San Jose, CA 95128 | 2019-10-29 |
| 1942842216 | Jodie Pierce | Marriage & Family Therapist | 871 Enborg Lane, San Jose, CA 95128 | 2019-10-08 |
| 1003466434 | Dong Mi Cha | Pharmacist | 777 Turner Dr Ste 330, San Jose, CA 95128 | 2019-09-17 |
| 1114571759 | Sleep Well Acupuncture, Inc | Acupuncturist | 1361 S Winchester Blvd Suite 206, San Jose, CA 95128 | 2019-08-01 |
| 1083277677 | Wellocity, Inc | Health Educator | 334 Santana Row, 318, San Jose, CA 95128 | 2019-04-18 |
| 1518428812 | Alexander Diaz | Radiology | 75 South Bascom Ave, San Jose, CA 95128 | 2019-03-28 |
| 1720542103 | Nanci R Price Inc | Chiropractor | 100 O'connor Dr., Ste 27, San Jose, CA 95128 | 2019-01-30 |
| Find all providers in zip 95128 | ||||
| Taxonomy Code | 310500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mental Illness |
| A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487282273 | Crestwood Behavioral Health, Inc. | Intermediate Care Facility, Mental Illness | 303 S C St, Lompoc, CA 93436-7305 | 2020-03-29 |
| 1497386569 | M&s Guesthomes, Inc. | Intermediate Care Facility, Mental Illness | 2424 W Glencrest Ave, Anaheim, CA 92801-3224 | 2020-01-28 |
| 1346711504 | Cedacal, LLC. | Intermediate Care Facility, Mental Illness | 5663 Cedarglen Dr, Azusa, CA 91702-5007 | 2018-12-16 |
| 1396213302 | Amazing Grace Oasis II | Intermediate Care Facility, Mental Illness | 8708 Bridgeport Ave, Hesperia, CA 92344-5562 | 2018-11-07 |
| 1972081651 | Oc Care Centers, Inc. | Intermediate Care Facility, Mental Illness | 127 N Queensbury St, Anaheim, CA 92806-3814 | 2018-08-03 |
| 1659858868 | Athina Kamar | Intermediate Care Facility, Mental Illness | 5826 Jumilla Ave, Woodland Hills, CA 91367-5604 | 2018-07-20 |
| 1447758024 | Crestwood Behavioral Health Inc | Intermediate Care Facility, Mental Illness | 450 Stanyan St Fl 5, San Francisco, CA 94117-1019 | 2018-01-29 |
| 1376067439 | Alacar. Inc | Intermediate Care Facility, Mental Illness | 4640 E Kaviland Ave, Fresno, CA 93725-1632 | 2017-07-31 |
| 1912358904 | American Helath Services | Intermediate Care Facility, Mental Illness | 1524 W 227th St Apt 1, Torrance, CA 90501-4917 | 2016-06-30 |
| 1639547896 | Arcaida Home Care & Staffing | Intermediate Care Facility, Mental Illness | 1090 E Cypress Ave, Suite B, Redding, CA 96002-1163 | 2015-09-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.