| Juvenile Justice - Csoc | |
|
2215 Blue Gum Ave Modesto CA 95358-1052 | |
| (209) 525-6225 | |
| Not Available |
| Full Name | Juvenile Justice - Csoc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2215 Blue Gum Ave, 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 |
|---|---|
| Juvenile Justice - Csoc 800 Scenic Drive Bldg. 4 Modesto CA 95350-6131 Ph: (209) 525-6225 | Juvenile Justice - Csoc 2215 Blue Gum Ave Modesto CA 95358-1052 Ph: (209) 525-6225 |
| NPI Number | 1174651236 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 03/10/2022 |
| Certification Date | 03/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174651236 | NPI | - | NPPES |
| 5048 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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