NPIMap

Organization Active NPI

Crestwood Behavioral Health, Inc.

Doing business as Cordilleras Health & Healing Ponderosa House

  • Mental Illness Intermediate Care Facility
  • Redwood City, CA
National Provider Identifier
1528822343
Registry record updated Feb 12, 2024
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
Cordilleras Health & Healing Ponderosa House
Practice address
280 Edmonds Road, BLDG B
Redwood City, CA 94062
Phone
(209) 955-2364
Fax
(209) 671-1520
NPI assigned
Feb 12, 2024
Last updated
Feb 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CRESTWOOD BEHAVIORAL HEALTH,INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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 Reimb.
Phone
(209) 955-2364

Specialties & licenses 1

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

Addresses

Primary practice location

280 Edmonds Road, BLDG B
Redwood City, CA 94062

Mailing address

7590 Shoreline Dr
Stockton, CA 95219-5455
Phone (209) 955-2316

Other names 1

  • Cordilleras Health & Healing Ponderosa House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Crestwood Center Behavioral Health Inc71 organizations share this tax ID, including this one
Part of
Crestwood Center Behavioral Health Inc

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

Locations

280 Edmonds Rd
Bldg B
Redwood City, CA 94062
Phone (209) 955-2364

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1528822343",
    "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": "209-955-2316",
            "fax_number": "209-671-1520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 EDMONDS ROAD, BLDG B",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94062",
            "telephone_number": "209-955-2364",
            "fax_number": "209-671-1520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD BEHAVIORAL HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRESTWOOD BEHAVIORAL HEALTH,INC.",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR AR REIMB.",
        "authorized_official_telephone_number": "209-955-2364"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cordilleras Health & Healing Ponderosa House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redwood City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.