Healthcare Provider Details

I. General information

NPI: 1427671429
Provider Name (Legal Business Name): FELLOWSHIP HEALTH RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 ATLANTIC AVE
MILTON DE
19968-1211
US

IV. Provider business mailing address

24 ALBION RD
LINCOLN RI
02865-3746
US

V. Phone/Fax

Practice location:
  • Phone: 302-854-0626
  • Fax: 302-752-1500
Mailing address:
  • Phone: 401-642-4416
  • Fax: 401-642-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN DUGGAN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 401-642-4410