Casa De Modesto Retirement Center

LBN: Fellowship Home, Inc
Casa De Modesto Retirement Center is an health care organization with primary practice located at 1745 Eldena Way , Modesto CA 95350-3568. The organization recently has 2 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Assisted Living Facility, Nursing & Custodial Care Facilities / Skilled Nursing Facility. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty. Fellowship Home, Inc can be contacted via phone (209) 529-4950, or through Wiest, Kelly via phone (209) 529-4950.

Contact Information

Primary practice address
1745 Eldena Way Modesto CA 95350-3568
Phone: (209) 529-4950
Fax: (209) 529-0957
Website:
Map and Directions
Authorized official contact:
Name: Wiest, Kelly
Phone: (209) 529-4950

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X 500300107 California
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X 507000572 California
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X 507000573 California
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X 507000802 California
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 100000019 California

Profile Details

NPI number 1750388732
LBN Legal business name Fellowship Home, Inc
DBA Doing business as Casa De Modesto Retirement Center
Authorized official Wiest, Kelly
Entity Organization
Organization subpart 1 No
Enumeration date Jul 5th, 2005
Last updated Dec 7th, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750388732 NPPES
California MEDICAID 05A047

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