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General NPI Number Information
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NPI Number | 1720796907
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Entity Type | Organization
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Legal Business Name | MODESTO GOSPEL MISSION
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1400 YOSEMITE BLVD
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City | MODESTO
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State | CA
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Zip | 95354-2840
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Country | US
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Telephone | 209-529-8259
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1203
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City | MODESTO
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State | CA
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Zip | 95353-1203
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Country | US
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Telephone | 529-225-2905
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Fax | 209-529-3450
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Authorized Official
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Title or Position | CEO
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Name | JASON ALLEN CONWAY
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Credential |
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Telephone | 209-225-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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