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General NPI Number Information
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NPI Number | 1760339717
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Entity Type | Organization
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Legal Business Name | FELLOWSHIP ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 2345 MONTICELLO CIR
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City | PLANO
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State | TX
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Zip | 75075-6678
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Country | US
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Telephone | 214-407-1326
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 MONTICELLO CIR
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City | PLANO
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State | TX
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Zip | 75075-6678
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Country | US
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Telephone | 214-407-1326
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHANNA KIKONTWE
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Credential | RDH
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Telephone | 314-420-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SL0600X
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Taxonomy Name | Long-Term Care Clinical Nurse Specialist
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License Number |
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License Number State |
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