Provider Demographics
NPI:1336286350
Name:FELLOWSHIP SENIOR DAY CARE CENTER, INC
Entity Type:Organization
Organization Name:FELLOWSHIP SENIOR DAY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-766-6498
Mailing Address - Street 1:4530 JANICE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-5204
Mailing Address - Country:US
Mailing Address - Phone:404-766-6498
Mailing Address - Fax:404-766-6419
Practice Address - Street 1:4530 JANICE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-5204
Practice Address - Country:US
Practice Address - Phone:404-766-6498
Practice Address - Fax:404-766-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X, 261QD1600X
GA000682459B311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000682459CMedicaid
GA000682459DMedicaid
GA1013083278Medicaid
GA000682459BMedicaid