# FELLOWSHIP HOME, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Casa De Modesto Retirement Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750388732
- **Authorized official:** MR. KELLY WIEST (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (209) 529-4950

## Contact information

- **Practice address:** 1745 ELDENA WAY, MODESTO, CA 95350-3568
- **Practice address phone:** (209) 529-4950
- **Practice address fax:** (209) 529-0957
- **Mailing address:** 1745 ELDENA WAY, MODESTO, CA 95350-3568
- **Mailing address phone:** (209) 529-4950
- **Mailing address fax:** (209) 529-0957

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | 500300107 | CA | — |
| 310400000X | Assisted Living Facility | 507000572 | CA | — |
| 310400000X | Assisted Living Facility | 507000573 | CA | — |
| 310400000X | Assisted Living Facility | 507000802 | CA | — |
| 314000000X | Skilled Nursing Facility | 100000019 | CA | Yes |

## Other

- **Enumeration date:** 07/05/2005
- **Last updated:** 12/07/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05A047 | — | CA |