Organization
GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUBEN IMPERIAL MBA (BEHAVIORAL HEALTH INTERIM DIRECTOR)
(209) 525-6146
Entity
Organization
Contact information
Practice address
800 SCENIC DR, MODESTO, CA 95350-6131
(209) 525-6146
Mailing address
800 SCENIC DR, MODESTO, CA 95350-6131
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/26/2008
Last updated
10/10/2019
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