# MODESTO GOSPEL MISSION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720796907
- **Authorized official:** JASON ALLEN CONWAY (CEO)
- **Authorized official phone:** (209) 225-2905

## Contact information

- **Practice address:** 1400 YOSEMITE BLVD, MODESTO, CA 95354-2840
- **Practice address phone:** (209) 529-8259
- **Mailing address:** PO BOX 1203, MODESTO, CA 95353-1203
- **Mailing address phone:** (529) 225-2905
- **Mailing address fax:** (209) 529-3450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 177F00000X | Lodging Provider | — | — | Yes |
| 251B00000X | Case Management Agency | — | — | — |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | — | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | — | — |
| 282J00000X | Religious Nonmedical Health Care Institution | — | — | — |
| 385H00000X | Respite Care | — | — | — |

## Other

- **Enumeration date:** 11/07/2022
- **Last updated:** 07/29/2025