Organization Active NPI

Crestwood Behavioral Health Inc

  • Skilled Nursing Facility
  • Fremont, CA
National Provider Identifier
1902828403
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CRESTWOOD BEHAVIORAL HEALTH INC
Practice address
4303 Stevenson Blvd
Fremont, CA 94538-2645
Phone
(510) 651-1244
Fax
(510) 651-1127
NPI assigned
Jul 24, 2006
Organization subpart
Yes
Parent organization
CRESTWOOD BEHAVIORAL HEALTH INCAs reported in NPPES

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
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

4303 Stevenson Blvd
Fremont, CA 94538-2645

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
LTC90080FMedicaidCA

Other names 1

  • CRESTWOOD MANOR-FREMONT 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
05D0967966Crestwood Manor4303 Stevenson Blvd, Fremont, CA 94538Certificate of waiverNov 28, 2027

National Provider Directory

National Provider Directory
Part of
Crestwood Behavioral Health

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1902828403",
    "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": "4303 STEVENSON BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382645",
            "telephone_number": "510-651-1244",
            "fax_number": "510-651-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD BEHAVIORAL HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRESTWOOD BEHAVIORAL HEALTH INC",
        "enumeration_date": "2006-07-24",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC90080F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTWOOD MANOR-FREMONT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, 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.