NPIMap

Organization Active NPI

Olive Crest

  • Mental Illness Community Based Residential Treatment Facility
  • Perris, CA
National Provider Identifier
1174168397
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
OLIVE CREST
Practice address
20051 Vista del Lago Ste B
Perris, CA 92570-7170
Phone
(951) 238-1936
NPI assigned
Nov 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Authorized official

Name
Donald Verleur, MBA
Title
Chief Executive Officer
Phone
(714) 543-5437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

20051 Vista del Lago Ste B
Perris, CA 92570-7170

Mailing address

2130 E 4TH St Ste 200
Santa Ana, CA 92705-3818
Phone (714) 543-5437

Other identifiers 1

IdentifierTypeStateIssuer
3329MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Olive Crest31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1174168397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 E 4TH ST STE 200",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053818",
            "telephone_number": "714-543-5437",
            "fax_number": "714-543-5463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20051 VISTA DEL LAGO STE B",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925707170",
            "telephone_number": "951-238-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE CREST",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "VERLEUR",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "714-543-5437",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3329",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.