Organization
OLIVE CREST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD VERLEUR MBA (CHIEF EXECUTIVE OFFICER)
(714) 543-5437
Entity
Organization
Contact information
Practice address
20051 VISTA DEL LAGO STE A, PERRIS, CA 92570-7170
(951) 238-1383
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
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3326
—
CA
Enumeration date
11/12/2019
Last updated
12/15/2023
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