Healthcare Provider Details

I. General information

NPI: 1396531489
Provider Name (Legal Business Name): COUNTY OF STANISLAUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E HACKETT RD
MODESTO CA
95358-9415
US

IV. Provider business mailing address

250 E HACKETT RD
MODESTO CA
95358-9415
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIA MARQUEZ
Title or Position: LIEUTENANT
Credential:
Phone: 209-525-5648