Provider Demographics
NPI:1356646103
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:401-333-3984
Practice Address - Street 1:24 ALBION RD STE 420
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3744
Practice Address - Country:US
Practice Address - Phone:401-333-3980
Practice Address - Fax:401-333-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
PA134980261Q00000X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100814610-0021Medicaid