Provider Demographics
NPI:1629094891
Name:COUNTY OF STANISLAUS
Entity Type:Organization
Organization Name:COUNTY OF STANISLAUS
Other - Org Name:STANISLAUS COUNTY HEALTH SERVICES AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-558-7163
Mailing Address - Street 1:830 SCENIC DR
Mailing Address - Street 2:MODESTO, CA SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:209-558-7000
Mailing Address - Fax:
Practice Address - Street 1:830 SCENIC DR
Practice Address - Street 2:MODESTO, CA SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-558-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70758FOtherMEDICAL PROVIDER NUMBER
CAZZR11501FOtherMEDICAL PROVIDER NUMBER
CE0652OtherMEDICARE RAILROAD
CALAB10463FOtherMEDICAL
CABCP18531FOtherBCEDP
CAEXE70074FOtherMEDICAL PROVIDER NUMBER
CAGR0081280OtherMEDICAL GROUP PROVIDER N.
CAHAP18531FOtherMEDICAL
CACMM70751FOtherMEDICAL PROVIDER NUMBER
CACMM70753FOtherMEDICAL PROVIDER NUMBER
CACMM70759FOtherMEDICAL PROVIDER NUMBER
CACMM70762FOtherMEDICAL PROVIDER NUMBER
CARHM18531FOtherMEDICAL PROVIDER NUMBER
CACMM70757FOtherMEDICAL PROVIDER NUMBER
CACMM70760FOtherMEDICAL PROVIDER NUMBER
CAGR0081280OtherMEDICAL GROUP PROVIDER N.
CAEXE70074FOtherMEDICAL PROVIDER NUMBER
CAHAP18531FOtherMEDICAL