Healthcare Provider Details

I. General information

NPI: 1104179258
Provider Name (Legal Business Name): BHRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMFC48564
License Number StateCA

VIII. Authorized Official

Name: MRS. MADELYN SCHLAEPHER
Title or Position: DIRECTOR
Credential: PHD
Phone: 209-525-6225