| Community Corrections Annex For Medications | |
|
190 Hackett Road Modesto CA 95358 | |
| (209) 525-6225 | |
| Not Available |
| Full Name | Community Corrections Annex For Medications |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 190 Hackett Road, Modesto, California |
| Authorized Official Name and Position | Ruben Imperial (BEHAVIORAL HEALTH DIRECTOR) |
| Authorized Official Contact | 2095256225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Corrections Annex For Medications 800 Scenic Dr Modesto CA 95350-6131 Ph: (209) 525-6225 | Community Corrections Annex For Medications 190 Hackett Road Modesto CA 95358 Ph: (209) 525-6225 |
| NPI Number | 1265634281 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 09/02/2020 |
| Certification Date | 09/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265634281 | NPI | - | NPPES |
| 5040 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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