1710349972 NPI number — FELLOWSHIP HEALTH CARE LLC.

Table of content: (NPI 1710349972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710349972 NPI number — FELLOWSHIP HEALTH CARE LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELLOWSHIP HEALTH CARE LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISITING ANGELS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710349972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6205 ABERCORN ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-5540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-335-1020
Provider Business Mailing Address Fax Number:
912-201-1752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6205 ABERCORN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-335-1020
Provider Business Practice Location Address Fax Number:
912-201-1752
Provider Enumeration Date:
03/25/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERTZWIG
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
912-401-8730

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  025R0794 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)