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General NPI Number Information
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NPI Number | 1801077565
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Entity Type | Organization
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Legal Business Name | STANISLAUS COUNTY - HEALTH SERVICES AGENCY
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 820 SCENIC DR 830 SCENIC DRIVE
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City | MODESTO
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State | CA
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Zip | 95350-6131
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Country | US
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Telephone | 209-558-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 820 SCENIC DR 830 SCENIC DRIVE
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City | MODESTO
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State | CA
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Zip | 95350-6131
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Country | US
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Telephone | 209-558-7070
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Fax |
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Authorized Official
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Title or Position | LGA MAA/TCM COORDINATOR
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Name | MRS. LIZBETH HERNANDEZ
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Credential |
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Telephone | 209-558-4087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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