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General NPI Number Information
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NPI Number | 1750388732
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Entity Type | Organization
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Legal Business Name | FELLOWSHIP HOME, INC
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 1745 ELDENA WAY
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City | MODESTO
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State | CA
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Zip | 95350-3568
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Country | US
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Telephone | 209-529-4950
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Fax | 209-529-0957
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Provider Business Mailing Address
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Address Line | 1745 ELDENA WAY
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City | MODESTO
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State | CA
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Zip | 95350-3568
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Country | US
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Telephone | 209-529-4950
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Fax | 209-529-0957
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KELLY WIEST
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Credential |
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Telephone | 209-529-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 500300107
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 507000572
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 507000573
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 507000802
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100000019
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License Number State | CA
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