NPIMap

Organization Active NPI

Fellowship Village Inc.

Doing business as Fellowship Garden State Hospice

  • Community Based Hospice Care Agency
  • Basking Ridge, NJ
National Provider Identifier
1386191302
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
FELLOWSHIP VILLAGE INC.
Doing business as
Fellowship Garden State Hospice
Practice address
8000 Fellowship Rd
Basking Ridge, NJ 07920-3915
Phone
(908) 580-9519
Fax
(908) 580-5186
NPI assigned
Sep 7, 2016
Organization subpart
Yes
Parent organization
FELLOWSHIP VILLAGE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Authorized official

Name
Mr. Brian G Lawrence
Title
President & Ceo
Phone
(908) 580-3805

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

8000 Fellowship Rd
Basking Ridge, NJ 07920-3915

Mailing address

8000 Fellowship Rd
Basking Ridge, NJ 07920-3915
Phone (908) 580-9519

Other names 1

  • Fellowship Garden State Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161201001840 NJ Part A Provider - Hospice 4880506310 Practice locations: Whiting, NJ; Basking Ridge, NJ

Hospice certification: CCN 311584

Legal name
FELLOWSHIP VILLAGE INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 6, 2017
Last certification
Jan 5, 2021
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Jan 7, 1992 in NJ
Enrollment address
8000 Fellowship Rd
Basking Ridge, NJ 07920-3915

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Fellowship Village IncCCN 311584 · All quality measures
Ownership
Non-Profit
Certified
Dec 6, 2017
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2122090Fellowship Garden State Hospice8000 Fellowship Drive, Basking Ridge, NJ 07920Certificate of waiverNov 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Fellowship Village Inc2 organizations share this tax ID, including this one
Part of
Fellowship Village Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ted B Harvey Individual Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Richard M Morley Individual Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Dana C Eckerl Individual W-2 Managing EmployeeAd; Apr 29, 2024
Barbara Joan Dersh Individual Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Stanley J Morin Individual Corporate OfficerChairman Jan 1, 2016 100%
Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Jeffrey J Zenna Individual Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Brian G Lawrence Individual Corporate DirectorPresident Nov 1, 2015 100%
W-2 Managing EmployeeCeo Oct 1, 2016 100%
Brian J Kirkpatrick Individual Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Paul E Achenbach Individual Corporate OfficerVice Chairman Jan 1, 2016 100%
Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Louis R Matlack Individual Corporate DirectorMember Board of Directors Jan 1, 2016 100%
Arthur L Sheppell Individual Contracted Managing EmployeeMD; Jan 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1386191302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 FELLOWSHIP RD",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079203915",
            "telephone_number": "908-580-9519",
            "fax_number": "908-580-5186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 FELLOWSHIP RD",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079203915",
            "telephone_number": "908-580-9519",
            "fax_number": "908-580-5186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FELLOWSHIP VILLAGE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FELLOWSHIP VILLAGE INC",
        "enumeration_date": "2016-09-07",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "908-580-3805",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fellowship Garden State Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Basking Ridge, NJ

Sources for this page

Verify at the official NPI Registry.