Provider Demographics
NPI:1528790458
Name:FELLOWSHIP HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:FELLOWSHIP HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIZZY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-938-1216
Mailing Address - Street 1:2490 LEE BLVD STE 311
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1404
Mailing Address - Country:US
Mailing Address - Phone:216-465-2399
Mailing Address - Fax:
Practice Address - Street 1:2490 LEE BLVD STE 311
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1404
Practice Address - Country:US
Practice Address - Phone:216-465-2399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health