NPIMap

Organization Active NPI

The Fellowship Center Alcohol Services Program, Inc.

  • Substance Abuse Rehabilitation Facility
  • Escondido, CA
National Provider Identifier
1902808744
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
370009AN Issued in CA
Legal business name
THE FELLOWSHIP CENTER ALCOHOL SERVICES PROGRAM, INC.
Practice address
737 E Grand Ave
Escondido, CA 92025-4404
Phone
(760) 745-8478
Fax
(760) 745-1176
NPI assigned
Aug 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Authorized official

Name
Raymond J Diciccio, ASW, LAADC-CANPI 1982109682
Title
Program Director
Phone
(760) 745-8478

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 370009AN CA Primary

Addresses

Primary practice location

737 E Grand Ave
Escondido, CA 92025-4404

Mailing address

737 E Grand Ave
Escondido, CA 92025-4404
Phone (760) 745-8478

Other names 1

  • THE FELLOWSHIP CENTER Other name

National Provider Directory

National Provider Directory

Locations

737 E Grand Ave
Escondido, CA 92025
Phone (760) 745-8478

Practitioners & affiliated clinicians

Practitioners 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539907200000",
    "number": "1902808744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 E GRAND AVE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920254404",
            "telephone_number": "760-745-8478",
            "fax_number": "760-745-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 E GRAND AVE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920254404",
            "telephone_number": "760-745-8478",
            "fax_number": "760-745-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FELLOWSHIP CENTER ALCOHOL SERVICES PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2018-10-19",
        "status": "A",
        "authorized_official_last_name": "DICICCIO",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "760-745-8478",
        "authorized_official_credential": "ASW, LAADC-CA"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "370009AN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE FELLOWSHIP CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "THE FELLOWSHIP CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; 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.