Healthcare Provider Details

I. General information

NPI: 1013083278
Provider Name (Legal Business Name): FELLOWSHIP SENIOR DAY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
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:
Mailing address:
  • Phone: 404-766-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number000682459A
License Number StateGA

VIII. Authorized Official

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