Organization
COUNTY OF STANISLAUS
Active
Parent organization
COUNTY OF STANISLAUS
Other names
Children's Intensive Community Support
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF STANISLAUS
Authorized official
RUBEN IMPERIAL MBA (BEHAVIORAL HEALTH DIRECTOR)
(209) 525-6225
Entity
Organization
Contact information
Practice address
100 POPLAR AVE, MODESTO, CA 95354-0510
(209) 558-7494
Mailing address
1601 I ST., STE. 200, 2ND FL., MODESTO, CA 95354-1110
(209) 525-6225
(209) 558-4326
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5024
—
CA
01
—
ZZZ15529Z
MEDICARE ID
—
01
—
ZZZ15533Z
MEDICARE ID
—
01
—
ZZZ15535Z
MEDICARE ID
—
01
—
ZZZ15536Z
MEDICARE ID
—
Enumeration date
02/28/2007
Last updated
08/07/2025
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