Organization
COUNTY OF STANISLAUS
Active
Other names
Stanislaus County Health Services Agency Rehabilitation Department
Organization subpart
No
Provider details
NPI number
Authorized official
MARYANN LEE (MANAGING DIRECTOR)
(209) 558-7163
Entity
Organization
Contact information
Practice address
830 SCENIC DRIVE, SUITE B, MODESTO, CA 95350-6131
(209) 558-7000
Mailing address
830 SCENIC DRIVE, SUITE B, MODESTO, CA 95350-6131
(209) 558-7000
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMM70759F
MEDICAL
CA
01
—
ZZZ21961Z
MEDICARE
CA
Enumeration date
03/09/2010
Last updated
03/09/2010
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