FELLOWSHIP HEALTH RESOURCES, INC

Provider Demographics

• NPI: 1245239680
• Name: FELLOWSHIP HEALTH RESOURCES, INC
• Entity Type: Organization
• Organization Name: FELLOWSHIP HEALTH RESOURCES, INC
• Other - Org Name: ELWYN ADULT BEHAVIORAL HEALTH SERVICES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: DIRECTOR OF FINANCE
• Authorized Official - First Name: STEPHEN
• Authorized Official - Last Name: DUGGAN
• Authorized Official - Phone: 401-642-4410
• Mailing Address - Street 1: 24 ALBION RD
• Mailing Address - Street 2: SUITE 420
• Mailing Address - City: LINCOLN
• Mailing Address - State: RI
• Mailing Address - Zip Code: 02865-3311
• Mailing Address - Country: US
• Mailing Address - Phone: 401-642-4416
• Mailing Address - Fax: 401-642-4453
• Practice Address - Street 1: 24 ALBION RD
• Practice Address - Street 2: SUITE 420
• Practice Address - City: LINCOLN
• Practice Address - State: RI
• Practice Address - Zip Code: 02865-3311
• Practice Address - Country: US
• Practice Address - Phone: 401-642-4416
• Practice Address - Fax: 401-642-4453
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-07-19
• Last Update Date: 2023-09-06

Provider Licenses

State	License ID	Taxonomies
		175T00000X, 251B00000X
DE		251B00000X, 261Q00000X
MA		251B00000X, 320800000X
RI		251B00000X, 320800000X
VA		251B00000X, 320800000X
PA		261Q00000X
NC	MHL-092-684	261QM0850X
ME		320800000X
NC		320800000X
NC	MHL-092-683	324500000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	251B00000X	Agencies	Case Management
No	175T00000X	Other Service Providers	Peer Specialist		Group - Multi-Specialty
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center		Group - Multi-Specialty
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health
No	320800000X	Residential Treatment Facilities	Community Based Residential Treatment Facility, Mental Illness
No	324500000X	Residential Treatment Facilities	Substance Abuse Rehabilitation Facility		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
DE	000656461	Medicaid
DE	10000656461	Medicaid
ME	15626000	Medicaid
RI	NE02149	Medicaid
PA	100814610-0019	Medicaid
PA	100814610-0018	Medicaid
VA	004945662	Medicaid
PA	100814610-0020	Medicaid
VA	004944038	Medicaid
RI	NE02148	Medicaid
PA	100814610-0013	Medicaid
PA	100814610-0023	Medicaid
DE	1000022578	Medicaid