Modesto Residential Living Center

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

MODESTO RESIDENTIAL LIVING CENTER

Practice address

1932 Evergreen Ave
Modesto, CA 95350-3738

Phone

(209) 530-9300

Fax

(209) 530-9303

NPI assigned

Apr 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dennis A Monterosso

Title

Owner

Phone

(209) 530-9300

Specialties & licenses 1

Addresses

Other names 1

• Modesto RLC,LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720207418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 EVERGREEN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503738",
            "telephone_number": "209-530-9300",
            "fax_number": "209-530-9303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1932 EVERGREEN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503738",
            "telephone_number": "209-530-9300",
            "fax_number": "209-530-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO RESIDENTIAL LIVING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONTEROSSO",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-530-9300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modesto RLC,LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Modesto, CA
• Providers in Modesto, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.