| Children's Intensive Community Support | |
|
421 E Morris Ave Bldg A Modesto CA 95354-0437 | |
| (209) 558-7494 | |
| Not Available |
| Full Name | Children's Intensive Community Support |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 421 E Morris Ave Bldg A, Modesto, California |
| Authorized Official Name and Position | Tony Vartan (BEHAVIORAL HEALTH DIRECTOR) |
| Authorized Official Contact | 2095256225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Intensive Community Support 1601 I St., Ste. 200, 2nd Fl. Modesto CA 95354-1110 Ph: (209) 525-6225 | Children's Intensive Community Support 421 E Morris Ave Bldg A Modesto CA 95354-0437 Ph: (209) 558-7494 |
| NPI Number | 1043348485 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 04/30/2024 |
| Certification Date | 04/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043348485 | NPI | - | NPPES |
| ZZZ15535Z | Other | MEDICARE ID | |
| 5024 | Medicaid | CA | |
| ZZZ15529Z | Other | MEDICARE ID | |
| ZZZ15533Z | Other | MEDICARE ID | |
| ZZZ15536Z | Other | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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