Provider Demographics
NPI:1902672629
Name:COUNTY OF STANISLAUS
Entity Type:Organization
Organization Name:COUNTY OF STANISLAUS
Other - Org Name:STANISLAUS MOBILE CRISIS TEAM
Other - Org Type:Other Name
Authorized Official - Title/Position:BHRS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-525-6225
Mailing Address - Street 1:1601 I ST., STE. 200, 2ND FL.
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1110
Mailing Address - Country:US
Mailing Address - Phone:209-525-6225
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE STE D
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-525-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF STANISLAUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health