CRESTWOOD BEHAVIORAL HEALTH (NPI# 1487031472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487031472 |
| Entity Type | Organization |
| Organization Name | CRESTWOOD BEHAVIORAL HEALTH |
| Practice Address |
4411 E Kings Canyon Rd Fresno CA 93702-3604 |
| Practice Telephone | 5596007177 |
| Practice Fax Number | 5596007737 |
| Mailing Telephone | 5596007177 |
| Mailing Fax Number | 5596007737 |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |
| Authorized Official Name | MARIA LOURDES DIAZ (REGISTERED NURSE) |
| Authorized Official Telephone | 5594579720 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | 700143 | CA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CALIFORNIA BOARD OF REGISTERED NURSING | 700143 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750718318 | Crestwood Behavioral Health | Psychiatric Residential Treatment Facility | 550 Patterson Blvd, Pleasant Hill, CA 94523-4155 | 2013-09-27 |
| Street Address |
4411 E KINGS CANYON RD |
| City | FRESNO |
| State | CA |
| Zip Code | 93702-3604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649275132 | Marianne Elena Tur | Nurse Practitioner | 4411 E Kings Canyon Rd, Fresno, CA 93702 | 2005-06-20 |
| 1992304653 | Ronda Denise Lincoln | Registered Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-10-22 |
| 1871100248 | Tanveer Hans | Licensed Psychiatric Technician | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-09-29 |
| 1568079192 | Samantha Hagerman | Registered Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-09-28 |
| 1952917130 | Aly Kelly Ly | Registered Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-09-22 |
| 1144848615 | Jennifer Salinas | Licensed Vocational Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-07-10 |
| 1144848052 | Amarvir Khroud | Registered Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-07-07 |
| 1841818994 | Maria Lourdes Aguilar | Licensed Vocational Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-07-06 |
| 1366069577 | Ulysses Ruvalcaba | Licensed Psychiatric Technician | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-07-03 |
| 1013532316 | Nada Moua | Registered Nurse | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2020-06-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730644543 | Brandy Eugena Dickey | Licensed Vocational Nurse | 496 S. Barton St., Fresno, CA 93702 | 2019-02-06 |
| 1205308269 | Kelly Ramirez | Counselor | 496 S. Barton St, Fresno, CA 93702 | 2018-12-31 |
| 1518437995 | Kimberlin Ann Klein | Licensed Vocational Nurse | 4411 E Kings Canyon Rd #319, Fresno, CA 93702 | 2018-11-28 |
| 1932677317 | Simone Danielle Cato | Counselor | 496 S Barton St, Fresno, CA 93702 | 2018-11-05 |
| 1558879841 | Mekdes Elizabeth Yilma | Marriage & Family Therapist | 4144 E. Kings Canyon Rd., Fresno, CA 93702 | 2018-01-20 |
| 1831647874 | Rick Foster | Registered Nurse | 441 East Kings Canyon Ave, Fresno, CA 93702 | 2016-09-20 |
| 1770935140 | Diana L. Eaglin | Registered Nurse | 4409 E. Inyo St., Modular A, Fresno, CA 93702 | 2016-07-08 |
| 1700257243 | Elizabeth Lee | Registered Nurse | 4411 E.kings Canyon Rd, Fresno, CA 93702 | 2015-10-09 |
| 1548657299 | Brandi Lynn Rieux | Counselor | 496 S. Barton Ave, Fresno, CA 93702 | 2015-04-21 |
| 1891069548 | Tamara Taylor | Case Manager/Care Coordinator | 890 S. Tenth Street, Fresno, CA 93702 | 2012-02-28 |
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| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588148035 | Discovery Practice Management, Inc. | Psychiatric Residential Treatment Facility | 214 W Bluff Ave, Fresno, CA 93711-6930 | 2018-09-20 |
| 1891260576 | Sierra Meadows Behavioral Health | Psychiatric Residential Treatment Facility | 7065 N Maple Ave Ste 104, Fresno, CA 93720 | 2018-10-09 |
| 1912159344 | Fresno County Behavioral Health | Psychiatric Residential Treatment Facility | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2008-10-16 |
| 1558499749 | Fresno County Crestwood Fresno Bridge | Psychiatric Residential Treatment Facility | 153 N U St, Fresno, CA 93701-2438 | 2007-03-01 |
| 1104978022 | Fresno County Apollo Residential Prog. | Psychiatric Residential Treatment Facility | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679172720 | Meadows | Psychiatric Residential Treatment Facility | 6395 Meadows Ct, Malibu, CA 90265-1706 | 2020-10-20 |
| 1912506064 | Point Dume | Psychiatric Residential Treatment Facility | 29149 Cliffside Dr, Malibu, CA 90265-4215 | 2020-10-20 |
| 1275132326 | Beach House | Psychiatric Residential Treatment Facility | 29245 Cliffside Dr, Malibu, CA 90265-4268 | 2020-10-20 |
| 1376159566 | 3855 Brunston LLC | Psychiatric Residential Treatment Facility | 3855 Brunston Ct, Westlake Village, CA 91362-5130 | 2020-09-22 |
| 1649884909 | Montage Recovery Ca LLC | Psychiatric Residential Treatment Facility | 2890 Kana Dume, Malibu, CA 90265 | 2020-09-03 |
| 1245844596 | Montage Recovery California | Psychiatric Residential Treatment Facility | 15367 Valley Vista Blvd, Sherman Oaks, CA 91403 | 2020-09-03 |
| 1063024644 | Crownview Psychiatric Institute | Psychiatric Residential Treatment Facility | 1110 Camino Del Sol Cir, Carlsbad, CA 92008-3509 | 2020-08-17 |
| 1215545652 | Elevation Behavioral Health | Psychiatric Residential Treatment Facility | 3836 Kanan Rd, Agoura Hills, CA 91301-3237 | 2020-07-22 |
| 1053929273 | Montage Recovery Solutions | Psychiatric Residential Treatment Facility | 17801 Twilight Ln, Encino, CA 91316-4330 | 2020-07-14 |
| 1225646441 | Montage Recovery Solutions | Psychiatric Residential Treatment Facility | 2900 S Kanan Dume Rd, Malibu, CA 90265-2792 | 2020-07-14 |
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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.