Healthcare Provider Details

I. General information

NPI: 1760532758
Provider Name (Legal Business Name): EMPLOYEE ASSISTANCE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 CELESTE DR 220
MODESTO CA
95355-2434
US

IV. Provider business mailing address

1316 CELESTE DR 220
MODESTO CA
95355-2434
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax: 209-569-7386
Mailing address:
  • Phone: 209-526-4500
  • Fax: 209-569-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. SHELLY SUE EDWARDS
Title or Position: MANAGER
Credential: LCSW
Phone: 209-526-4500