Provider Demographics
NPI:1245975598
Name:FELLOWSHIP AND COMMUNITY CENTER
Entity type:Organization
Organization Name:FELLOWSHIP AND COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:CT, RMA
Authorized Official - Phone:929-232-2793
Mailing Address - Street 1:249 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4946
Mailing Address - Country:US
Mailing Address - Phone:192-923-2279
Mailing Address - Fax:
Practice Address - Street 1:249 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4946
Practice Address - Country:US
Practice Address - Phone:192-923-2279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management