Provider Demographics
NPI:1679642060
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, HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
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:PO BOX 3088
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-3088
Mailing Address - Country:US
Mailing Address - Phone:209-558-8118
Mailing Address - Fax:209-558-8620
Practice Address - Street 1:1325 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3922
Practice Address - Country:US
Practice Address - Phone:209-558-8118
Practice Address - Fax:209-558-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCS00057F261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation