NPIMap

Organization Active NPI

Crestwood Behavioral Health, Inc.

  • Mental Illness Intermediate Care Facility
  • Vallejo, CA
National Provider Identifier
1508935834
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
02060027 Issued in CA
Legal business name
CRESTWOOD BEHAVIORAL HEALTH, INC.
Practice address
115 Oddstad Dr
Vallejo, CA 94589-2520
Phone
(707) 552-0215
Fax
(707) 553-1424
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Authorized official

Name
Michelle Smith
Title
Executive Director Reimbursement
Phone
(209) 955-2364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 02060027 CA Primary

Addresses

Primary practice location

115 Oddstad Dr
Vallejo, CA 94589-2520

Mailing address

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

Other names 1

  • CRESTWOOD RECOVERY & REHAB. CENTER Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0861563Crestwood Recovery & Rehab Center115 Oddstad Dr, Vallejo, CA 94589Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Crestwood Behavioral Health71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1508935834",
    "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": "209-952-5314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ODDSTAD DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892520",
            "telephone_number": "707-552-0215",
            "fax_number": "707-553-1424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD BEHAVIORAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR REIMBURSEMENT",
        "authorized_official_telephone_number": "209-955-2364"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "CA",
            "license": "02060027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTWOOD RECOVERY & REHAB. CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.