Healthcare Provider Details

I. General information

NPI: 1376723668
Provider Name (Legal Business Name): STANISLAUS COUNTY BEHAVIORAL HELATH AND RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 SPYRES WAY SUIT 7
MODESTO CA
95356-9800
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax: 209-558-8031
Mailing address:
  • Phone: 209-588-4595
  • Fax: 209-558-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMW20309
License Number StateCA

VIII. Authorized Official

Name: JANETTE JAMESON
Title or Position: PROGRAM COODINATOR
Credential:
Phone: 209-558-5495