Healthcare Provider Details

I. General information

NPI: 1366648016
Provider Name (Legal Business Name): COUNTY OF STANISLAUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 THIRD STREET
HUGHSON CA
95326-0249
US

IV. Provider business mailing address

PO BOX 249
HUGHSON CA
95326-0249
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-7250
  • Fax:
Mailing address:
  • Phone: 209-558-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN LEE
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 209-558-7163