Basic Information
| Provider Information | |||||||||
| NPI: | 1356646103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FELLOWSHIP HEALTH RESOURCES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 ALBION RD STE 420 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028653744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013333980 | ||||||||
| FaxNumber: | 4013333984 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 ALBION RD STE 420 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028653744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013333980 | ||||||||
| FaxNumber: | 4013333984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2011 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | DUGGAN | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4016424410 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | PA | N | Agencies | Case Management | 261QM0850X | 134980 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261Q00000X | 134980 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.