Fellowship Home, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100000019 Issued in CA

Legal business name

FELLOWSHIP HOME, INC

Doing business as

Casa De Modesto Retirement Center

Practice address

1745 Eldena Way
Modesto, CA 95350-3568

Phone

(209) 529-4950

Fax

(209) 529-0957

NPI assigned

Jul 5, 2005

Last updated

Dec 7, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kelly Wiest

Title

Executive Director

Phone

(209) 529-4950

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Casa De Modesto Retirement Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1750388732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 ELDENA WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503568",
            "telephone_number": "209-529-4950",
            "fax_number": "209-529-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 ELDENA WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503568",
            "telephone_number": "209-529-4950",
            "fax_number": "209-529-0957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FELLOWSHIP HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "WIEST",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-529-4950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "500300107",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "507000572",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "507000573",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "507000802",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "100000019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05A047",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Casa De Modesto Retirement Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Federico Caceres DDS Inc. (Synergy Dental)
• Ariel Feifel, MD
• Fredric Warren Feist Jr., M.D.
• Andrea Felix Gastelum
• Wesley E E Felix
• Angelica Elizabeth Felt
• Stacy Felt
• Heather Fenn Carey, HS DIPLOMA
• Brandice Ferguson
• Wess J Ferguson, M.F.T.

• Skilled Nursing Facility in Modesto, CA
• Providers in Modesto, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.