Healthcare Provider Details

I. General information

NPI: 1881607299
Provider Name (Legal Business Name): FELLOWSHIP HEALTH RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18090 HARBESON RD
MILTON DE
19968-2841
US

IV. Provider business mailing address

24 ALBION RD STE 420
LINCOLN RI
02865-3744
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-4400
  • Fax: 302-684-2943
Mailing address:
  • Phone: 401-333-3980
  • Fax: 401-334-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1703
License Number StateDE

VIII. Authorized Official

Name: DONNA BUSCH
Title or Position: DIR CONTRACTS & CREDENTIALING
Credential:
Phone: 445-206-3028