Provider Demographics
NPI:1295868305
Name:STANISLAUS COUNTY BHRS
Entity Type:Organization
Organization Name:STANISLAUS COUNTY BHRS
Other - Org Name:STANISLAUS RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORAL HEALTH INTERIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMPERIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
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:209-525-6225
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-541-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANISLAUS COUNTY BHRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility