1649303546 NPI number — STANISLAUS COUNTY BHRS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649303546 NPI number — STANISLAUS COUNTY BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANISLAUS COUNTY BHRS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649303546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 SCENIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-525-6225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CERES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95307-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-541-2191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEGETTE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
BEHAVIORAL HEALTH DIRECTOR
Authorized Official Telephone Number:
209-525-6225

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50AT , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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