NPIMap

Organization Active NPI

Crestwood Behavioral Health, Inc.

Doing business as Kingsburg Healing Center

  • Mental Illness Intermediate Care Facility
  • Kingsburg, CA
National Provider Identifier
1073989661
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
Legal business name
CRESTWOOD BEHAVIORAL HEALTH, INC.
Doing business as
Kingsburg Healing Center
Practice address
1200 Smith St
Kingsburg, CA 93631-2216
Phone
(209) 955-2328
Fax
(209) 644-5721
NPI assigned
Aug 18, 2015
Last updated
Nov 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle Smith
Title
Executive Director Ar and Reimb.
Phone
(209) 955-2364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X NU Primary

Addresses

Primary practice location

1200 Smith St
Kingsburg, CA 93631-2216

Mailing address

7590 Shoreline Dr
Stockton, CA 95219-5455
Phone (209) 955-2328

Other names 1

  • Kingsburg Healing Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Crestwood PHF Sacramento71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1073989661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7590 SHORELINE DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952195455",
            "telephone_number": "209-955-2328",
            "fax_number": "209-644-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SMITH ST",
            "city": "KINGSBURG",
            "state": "CA",
            "postal_code": "936312216",
            "telephone_number": "209-955-2328",
            "fax_number": "209-644-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD BEHAVIORAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR AR AND REIMB.",
        "authorized_official_telephone_number": "209-955-2364"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingsburg Healing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kingsburg Healing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingsburg, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.