Provider Demographics
NPI:1013083278
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:MR
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000682459A311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)