Organization
FELLOWSHIP HOME, INC
Active
Other names
Casa De Modesto Retirement Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY WIEST (EXECUTIVE DIRECTOR)
(209) 529-4950
Entity
Organization
Contact information
Practice address
1745 ELDENA WAY, MODESTO, CA 95350-3568
(209) 529-4950
(209) 529-0957
Mailing address
1745 ELDENA WAY, MODESTO, CA 95350-3568
(209) 529-4950
(209) 529-0957
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
100000019
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05A047
—
CA
Enumeration date
07/05/2005
Last updated
12/07/2016
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