Healthcare Provider Details

I. General information

NPI: 1689744492
Provider Name (Legal Business Name): STANISLAUS COUNTY BHRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 I ST., STE. 200, 2ND FL.
MODESTO CA
95354-1110
US

IV. Provider business mailing address

1601 I ST., STE. 200, 2ND FL.
MODESTO CA
95354-1110
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 TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

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