Healthcare Provider Details

I. General information

NPI: 1477310381
Provider Name (Legal Business Name): FELLOWSHIP HEALTH RESOURCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S SPRINGVIEW DR
DOVER DE
19901-5550
US

IV. Provider business mailing address

24 ALBION RD STE 420
LINCOLN RI
02865-3744
US

V. Phone/Fax

Practice location:
  • Phone: 302-390-5372
  • Fax:
Mailing address:
  • Phone: 401-642-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DONNA BUSCH
Title or Position: DIRECTOR OF CONTRACTS AND CREDENTIA
Credential:
Phone: 445-206-3028