Healthcare Provider Details

I. General information

NPI: 1336286350
Provider Name (Legal Business Name): FELLOWSHIP SENIOR DAY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 JANICE DR
COLLEGE PARK GA
30337-5204
US

IV. Provider business mailing address

4530 JANICE DR
COLLEGE PARK GA
30337-5204
US

V. Phone/Fax

Practice location:
  • Phone: 404-766-6498
  • Fax: 404-766-6419
Mailing address:
  • Phone: 404-766-6498
  • Fax: 404-766-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number000682459B
License Number StateGA

VIII. Authorized Official

Name: DOMINIQUE NAAR
Title or Position: DIRECTOR
Credential:
Phone: 404-766-6498