Provider Demographics
NPI:1457480642
Name:STANISLAUS COUNTY BHRS
Entity Type:Organization
Organization Name:STANISLAUS COUNTY BHRS
Other - Org Name:MHSA HEALTH/MENTAL HEALTH TEAM
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGETTE
Authorized Official - Suffix:
Authorized Official - Credentials: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:209-525-6885
Mailing Address - Fax:
Practice Address - Street 1:1301 G ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2421
Practice Address - Country:US
Practice Address - Phone:209-525-7423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANISLAUS COUNTY BHRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50A8Medicaid
ZZZ06630ZOtherMEDICARE
CABV659BMedicaid