Provider Demographics
NPI:1386187052
Name:FELLOWSHIP HEALTH TEAM LLC
Entity Type:Organization
Organization Name:FELLOWSHIP HEALTH TEAM LLC
Other - Org Name:SELECT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALT ADMIN/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-338-2557
Mailing Address - Street 1:1305 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2263
Mailing Address - Country:US
Mailing Address - Phone:903-630-1405
Mailing Address - Fax:469-304-1133
Practice Address - Street 1:1305 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2263
Practice Address - Country:US
Practice Address - Phone:903-630-1405
Practice Address - Fax:469-304-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health