Provider Demographics
NPI:1386187052
Name:FELLOWSHIP HEALTH TEAM LLC
Entity type:Organization
Organization Name:FELLOWSHIP HEALTH TEAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-291-8670
Mailing Address - Street 1:801 E CAMPBELL RD STE 350A
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1889
Mailing Address - Country:US
Mailing Address - Phone:903-630-1405
Mailing Address - Fax:469-304-1133
Practice Address - Street 1:801 E CAMPBELL RD STE 350A
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1889
Practice Address - Country:US
Practice Address - Phone:903-630-1405
Practice Address - Fax:469-304-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health