Provider Demographics
NPI:1689744492
Name:STANISLAUS COUNTY BHRS
Entity Type:Organization
Organization Name:STANISLAUS COUNTY BHRS
Other - Org Name:BEHAVIORAL HEALTH & RECOVERY SERVICES
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:209-525-6225
Mailing Address - Fax:
Practice Address - Street 1:800 SCENIC DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-525-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANISLAUS COUNTY BHRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ20934ZOtherMEDICARE
ZZZ06630ZOtherMEDICARE
ZZZ31213ZOtherMEDICARE ID
ZZZ89558ZOtherMEDICARE ID
ZZZ93575ZOtherMEDICARE ID
ZZZ15534ZOtherMEDICARE ID
ZZZ15533ZOtherMEDICARE ID
ZZZ21961ZOtherMEDICARE ID
ZZZ15529ZOtherMEDICARE ID
ZZZP5010ZOtherMEDICARE ID
ZZZ26597ZOtherMEDICARE ID
ZZZ15535ZOtherMEDICARE ID
ZZZ15536ZOtherMEDICARE ID