1427671429 NPI number — FELLOWSHIP HEALTH RESOURCES, INC.

Table of content: (NPI 1427671429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427671429 NPI number — FELLOWSHIP HEALTH RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELLOWSHIP HEALTH RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427671429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 ALBION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02865-3746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-642-4416
Provider Business Mailing Address Fax Number:
401-642-4453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19968-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-854-0626
Provider Business Practice Location Address Fax Number:
302-752-1500
Provider Enumeration Date:
05/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DUGGAN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
401-642-4410

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 323P00000X . This is a "WASHINGTON PUBLISING CO" identifier . This identifiers is of the category "OTHER".




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