Healthcare Provider Details

I. General information

NPI: 1720111545
Provider Name (Legal Business Name): COUNTY OF STANISLAUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG F
MODESTO CA
95350-6131
US

IV. Provider business mailing address

1601 I ST., STE. 200, 2ND FLOOR
MODESTO CA
95354
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6150
  • Fax: 209-558-4339
Mailing address:
  • Phone: 209-525-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUBEN IMPERIAL
Title or Position: BEHAVIORIAL HEALTH DIRECTOR
Credential: MBA
Phone: 209-525-6225