Provider Demographics
NPI:1801077565
Name:STANISLAUS COUNTY - HEALTH SERVICES AGENCY
Entity type:Organization
Organization Name:STANISLAUS COUNTY - HEALTH SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LGA MAA/TCM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-558-4087
Mailing Address - Street 1:820 SCENIC DR
Mailing Address - Street 2:830 SCENIC DRIVE
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:209-558-7070
Mailing Address - Fax:
Practice Address - Street 1:820 SCENIC DR
Practice Address - Street 2:830 SCENIC DRIVE
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-558-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANISLAUS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management