Provider Demographics
NPI:1346253747
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 - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-642-4410
Mailing Address - Street 1:24 ALBION RD STE 420
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3744
Mailing Address - Country:US
Mailing Address - Phone:401-333-3980
Mailing Address - Fax:401-334-8862
Practice Address - Street 1:7549 WILKINS RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4106
Practice Address - Country:US
Practice Address - Phone:302-422-6699
Practice Address - Fax:302-422-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1517320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE001147061Medicaid