# GOSPEL CENTER RESCUE MISSION

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

## Provider details

- **NPI number:** 1902560014
- **Authorized official:** MRS. SANDRA ANN MAPLE-DEAVER (RECUPERATIVE CARE DIRECTOR)
- **Authorized official phone:** (209) 320-2327

## Contact information

- **Practice address:** 445 S SAN JOAQUIN ST, STOCKTON, CA 95203-3537
- **Practice address phone:** (209) 466-2138
- **Practice address fax:** (209) 466-4927
- **Mailing address:** 445 S SAN JOAQUIN ST, STOCKTON, CA 95203-3537
- **Mailing address phone:** (209) 466-2138
- **Mailing address fax:** (209) 466-4927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174200000X | Meals Provider | — | NULL | — |
| 177F00000X | Lodging Provider | — | NULL | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251X00000X | Supports Brokerage Agency | — | NULL | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | Yes |

## Other

- **Enumeration date:** 10/25/2021
- **Last updated:** 10/25/2021