Provider Demographics
NPI:1376723668
Name:STANISLAUS COUNTY BEHAVIORAL HELATH AND RECOVERY SERVICES
Entity Type:Organization
Organization Name:STANISLAUS COUNTY BEHAVIORAL HELATH AND RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COODINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-558-5495
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:209-588-4595
Mailing Address - Fax:209-558-8031
Practice Address - Street 1:4640 SPYRES WAY
Practice Address - Street 2:SUIT 7
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9800
Practice Address - Country:US
Practice Address - Phone:209-558-4595
Practice Address - Fax:209-558-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMW20309251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health