Fellowship Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

031-01-241-1 Issued in GA

Legal business name

FELLOWSHIP ASSISTED LIVING LLC

Doing business as

Fellowship Personal Care Home

Practice address

277 Medical Way
Riverdale, GA 30274-2522

Phone

(770) 909-0221

Fax

(770) 909-0219

NPI assigned

Feb 10, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dominique Naar, 4043767658

Title

Director

Phone

(404) 376-7658

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fellowship Personal Care Home Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1184162091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 MEDICAL WAY",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742522",
            "telephone_number": "770-909-0221",
            "fax_number": "770-909-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 MEDICAL WAY",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742522",
            "telephone_number": "770-909-0221",
            "fax_number": "770-909-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FELLOWSHIP ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-10",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "NAAR",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "404-376-7658",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "4043767658"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "031-01-241-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "860341286A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fellowship Personal Care Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Family Matters Safe Haven
• Evelyn Omowunmi Fatoye, M.D.
• Tabreeka M Faulkner, RN
• William C Feldman, DDS.,PC
• Felix Pelaez MD
• Anita Ferguson
• Field Labs Diagnostics
• Ivan Fields
• Yolanda Fitten
• Five Star Medical Supply

• Assisted Living Facility in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.