Provider Demographics
NPI:1174877823
Name:STANISLAUS COUNTY
Entity type:Organization
Organization Name:STANISLAUS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHS II
Authorized Official - Prefix:MS
Authorized Official - First Name:DAPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMB-PERRILLIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-558-4464
Mailing Address - Street 1:1010 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1208 9TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0713
Practice Address - Country:US
Practice Address - Phone:209-558-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization