CRESTWOOD BEHAVIORAL HEALTH,INC (NPI# 1972095701) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972095701 |
| Entity Type | Organization |
| Organization Name | CRESTWOOD BEHAVIORAL HEALTH,INC |
| Other Organization Name | CRESTWOOD CRISIS STABILIZATION SERVICES |
| Practice Address |
2101 Courage Dr Fairfield CA 94533 |
| Mailing Address |
7590 Shoreline Dr Stockton CA 95219-5455 |
| Practice Telephone | 2099552328 |
| Practice Fax Number | 2096445721 |
| Mailing Telephone | 2099552328 |
| Mailing Fax Number | 2096445721 |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-07 |
| Authorized Official Name | LORI BLACKBURN (CAO/TREASURER) |
| Authorized Official Telephone | 2099552322 |
| Is Organization Subpart | Y |
| Parent Organization Name | CRESTWOOD BEHAVIORAL HEALTH INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Crestwood Crisis Stabilization Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508884479 | Crestwood Behavioral Health,inc | Assisted Living Facility | 2201 Tuolumne St, Vallejo, CA 94589-2524 | 2006-07-18 |
| 1801001730 | Crestwood Behavioral Health,inc | Day Training, Developmentally Disabled Services | 2201 Tuolumne St, Vallejo, CA 94589-2524 | 2007-05-14 |
| Street Address |
2101 COURAGE DR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396736732 | Sarah Jane Bolger | Nurse Practitioner | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2005-11-03 |
| 1235754706 | Armina Roseanna Delacruz | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-06-10 |
| 1043834955 | Rodney Ralls | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-06-05 |
| 1740800531 | Cleveland Anthony Thibodeaux IIi | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-04-21 |
| 1477173672 | Lauren Elayna Lopez | Case Manager/Care Coordinator | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-04-17 |
| 1497388763 | Edward Lusung Mendoza | Licensed Vocational Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-02-14 |
| 1598397655 | Pamela Monterrosa | Student in an Organized Health Care Education/Training Program | 2101 Courage Dr, Fairfield, CA 94533 | 2020-02-06 |
| 1205476801 | Lemuel Francis Constantino | Registered Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-01-10 |
| 1285273490 | Simone Lenore Adkins | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-01-06 |
| 1376182857 | Sean Michael Maher | Registered Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2019-12-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457986457 | Compassionate Counseling LLC | Clinic/Center | 402 N B St Ste 104, Fairfield, IA 52556-2971 | 2020-03-10 |
| 1073648747 | Crestwood Behavioral Health, Inc. | Clinic/Center | 1945 Kidder Ave, Fairfield, CA 94533-3919 | 2007-02-22 |
| 1255823613 | Caminar | Clinic/Center | 1735 Enterprise Dr Ste 105a, Fairfield, CA 94533-6822 | 2018-06-01 |
| 1407913064 | Health & Social Services | Clinic/Center | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2007-01-03 |
| 1295890945 | Health and Social Services | Clinic/Center | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2006-12-23 |
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|---|---|---|---|---|
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| 1013523174 | Vitalis Wellness Center Inc. | Clinic/Center | 1519 Constitution Blvd Apt 201, Salinas, CA 93906-3150 | 2020-09-23 |
| 1083220453 | Sasha Jackson, LLC | Clinic/Center | 480 Ridge Creek Ln, Patterson, CA 95363-8776 | 2020-09-21 |
| 1003422486 | Nicholas Patrick Brown, Do | Clinic/Center | 419 Chestnut St Apt 3, Mount Shasta, CA 96067-2918 | 2020-09-21 |
| 1609481753 | Telecare Corporation | Clinic/Center | 8471 Enterprise Way, Oakland, CA 94621-1317 | 2020-09-14 |
| 1346854973 | A Home for Our Veterans | Clinic/Center | 1811 W 236th St, Torrance, CA 90501-5742 | 2020-09-01 |
| 1184238875 | Integrative Psychotherapy Group, A Marriage and Family Therapy Corp | Clinic/Center | 311 N Robertson Blvd Ste 718, Beverly Hills, CA 90211-1705 | 2020-09-01 |
| 1962016527 | Los Angeles County Department of Mental Health | Clinic/Center | 2934 E Garvey Ave South Ste 230, West Covina, CA 91791-6101 | 2020-09-01 |
| 1649883828 | Soul Solutions, LLC | Clinic/Center | 5100 N 6th St Ste 148, Fresno, CA 93710-7514 | 2020-08-26 |
| 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.