Provider Demographics
NPI:1396941464
Name:COUNTY OF STANISLAUS
Entity type:Organization
Organization Name:COUNTY OF STANISLAUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:401 PARADISE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-3104
Mailing Address - Country:US
Mailing Address - Phone:209-558-4000
Mailing Address - Fax:
Practice Address - Street 1:401 PARADISE RD
Practice Address - Street 2:SUITE E
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-3104
Practice Address - Country:US
Practice Address - Phone:209-558-4000
Practice Address - Fax:209-558-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70074FOtherMEDICAL
CAHAP70074FOtherFAMILY PACT
FHC70074FOtherMEDICAL
CA051117Medicare Oscar/Certification