Organization
FELLOWSHIP ASSISTED LIVING LLC
Active
Other names
Fellowship Personal Care Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOMINIQUE NAAR 4043767658 (DIRECTOR)
(404) 376-7658
Entity
Organization
Contact information
Practice address
277 MEDICAL WAY, RIVERDALE, GA 30274-2522
(770) 909-0221
(770) 909-0219
Mailing address
277 MEDICAL WAY, RIVERDALE, GA 30274-2522
(770) 909-0221
(770) 909-0219
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
031-01-241-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
860341286A
—
GA
Enumeration date
02/10/2017
Last updated
02/10/2017
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