Provider Demographics
NPI: | 1164555686 |
---|---|
Name: | STANISLAUS COUNTY |
Entity Type: | Organization |
Organization Name: | STANISLAUS COUNTY |
Other - Org Name: | CRESTWOOD BEHAVIORAL HEALTH CENTER - SAN JOSE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | BEHAVIORAL HEALTH DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DENISE |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | HUNT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN, MFT |
Authorized Official - Phone: | 209-525-6225 |
Mailing Address - Street 1: | 800 SCENIC DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MODESTO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95350-6131 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 209-525-7423 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1425 FRUITDALE AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95128-3234 |
Practice Address - Country: | US |
Practice Address - Phone: | 209-525-7423 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-13 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 50AK | Medicaid |