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Organization
OLIVE CREST
Active
Organization
OLIVE CREST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD A VERLEUR II MBA (CHIEF EXECUTIVE OFFICER)
(714) 543-5437
Entity
Organization
Contact information
Practice address
39820 PORTOLA AVE, PALM DESERT, CA 92260-0622
(760) 341-8507
(760) 341-8613
Mailing address
2130 E 4TH ST STE 200, SANTA ANA, CA 92705-3818
(714) 543-5437
(714) 543-5463
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
57111
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LE0518
MEDI-CAL
CA
Enumeration date
10/10/2016
Last updated
11/15/2023
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