# CRESTWOOD BEHAVIORAL HEALTH, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CRESTWOOD MANOR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730128174
- **Authorized official:** MRS. MICHELLE SMITH (EXECUTIVE DIRECTOR REIMBURSEMENT)
- **Authorized official phone:** (209) 955-2364

## Contact information

- **Practice address:** 1130 MONACO CT, STOCKTON, CA 95207-6704
- **Practice address phone:** (209) 478-2060
- **Practice address fax:** (209) 478-3175
- **Mailing address:** 7590 SHORELINE DR, STOCKTON, CA 95219-5455
- **Mailing address phone:** (209) 955-2328
- **Mailing address fax:** (209) 952-5314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 05/20/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR55075H | — | CA |