Provider Demographics
NPI:1902560014
Name:GOSPEL CENTER RESCUE MISSION
Entity Type:Organization
Organization Name:GOSPEL CENTER RESCUE MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECUPERATIVE CARE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAPLE-DEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-320-2327
Mailing Address - Street 1:445 S SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-3537
Mailing Address - Country:US
Mailing Address - Phone:209-466-2138
Mailing Address - Fax:209-466-4927
Practice Address - Street 1:445 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-3537
Practice Address - Country:US
Practice Address - Phone:209-466-2138
Practice Address - Fax:209-466-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)