Healthcare Provider Details

I. General information

NPI: 1407761877
Provider Name (Legal Business Name): STANISLAUS COUNTY AGING AND VETERANS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COFFEE, RD. STE. 19
MODESTO CA
95355-1315
US

IV. Provider business mailing address

3500 COFFEE, RD. STE. 19
MODESTO CA
95355-1315
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-7825
  • Fax:
Mailing address:
  • Phone: 209-558-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE REYES MICHEL JR.
Title or Position: DIRECTOR
Credential: MSW. MA
Phone: 209-525-4601