Healthcare Provider Details

I. General information

NPI: 1770208571
Provider Name (Legal Business Name): FELLOWSHIP HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 SANDERSON AVE
SCRANTON PA
18509-1853
US

IV. Provider business mailing address

1736 SANDERSON AVE
SCRANTON PA
18509-1853
US

V. Phone/Fax

Practice location:
  • Phone: 570-382-8157
  • Fax: 785-262-8423
Mailing address:
  • Phone: 570-382-8157
  • Fax: 845-262-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE MARIE BRIEGEL
Title or Position: DIRECTOR OF BILLING
Credential: CPB, CMRS
Phone: 570-881-4403