THE FELLOWSHIP CENTER ALCOHOL SERVICES PROGRAM, INC. (NPI# 1902808744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902808744 |
| Entity Type | Organization |
| Organization Name | THE FELLOWSHIP CENTER ALCOHOL SERVICES PROGRAM, INC. |
| Other Organization Name | THE FELLOWSHIP CENTER |
| Practice Address |
737 E Grand Ave Escondido CA 92025-4404 |
| Practice Telephone | 7607458478 |
| Practice Fax Number | 7607451176 |
| Mailing Telephone | 7607458478 |
| Mailing Fax Number | 7607451176 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2018-10-19 |
| Authorized Official Name | RAYMOND J DICICCIO (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 7607458478 |
| Authorized Official Credential | ASW, LAADC-CA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 370009AN | CA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| THE FELLOWSHIP CENTER | Other Name - Individual/Organization |
| Street Address |
737 E GRAND AVE |
| City | ESCONDIDO |
| State | CA |
| Zip Code | 92025-4404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942835459 | Roman Galindo | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-03-04 |
| 1598399321 | Michael Louis Ederson | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-03-02 |
| 1881228542 | Howard Cuney | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-03-02 |
| 1265066922 | Sean Kavanagh | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-03-02 |
| 1912531864 | Alexander Lee Smith | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-03-01 |
| 1720612773 | Celina Maria Toves | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-02-28 |
| 1376177337 | Ryan Lottes | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-02-28 |
| 1518591494 | Douglas John Bell | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-02-28 |
| 1669006615 | Rana Sanchez | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-02-28 |
| 1043844939 | Edward Robert Caldroni | Counselor | 737 E Grand Ave, Escondido, CA 92025-4404 | 2020-02-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962001230 | Tanya Geanna Macleod | Peer Specialist | 474 West Vermont Ave., Ste., 101, Escondido, CA 92025 | 2020-10-19 |
| 1801449640 | Jennifer Marsh | Marriage & Family Therapist | 403 N Escondido Blvd #533, Escondido, CA 92025 | 2019-07-21 |
| 1093281644 | Lucy Breen | Peer Specialist | 474 Weest Vermont Ave #104, Escondido, CA 92025 | 2018-10-22 |
| 1457834665 | Daniel & Max | Optometrist | 730 N Center City Parkway, Building A-1, Suite 101, Escondido, CA 92025 | 2018-09-13 |
| 1477033272 | Hyoshin Kwak | Acupuncturist | 106 S. Grape St, Suite 10, Escondido, CA 92025 | 2018-08-21 |
| 1467948877 | Irma P Garcia | Counselor | 337 West Mission Ave, Escondido, CA 92025 | 2018-07-09 |
| 1295235380 | Anna M. Rainville | Marriage & Family Therapist | 11701 San Pasqual Valley Rd, Escondido, CA 92025 | 2018-02-15 |
| 1689187049 | Monica Pino | Occupational Therapist | 469 E Grand Avenue, Escondido, CA 92025 | 2017-11-08 |
| 1427569581 | Mtk Primary Care Medical Group | Specialist | 1835a S Centre City Pkwy Ste 459, Escondido, CA 92025 | 2017-10-17 |
| 1619490349 | Elizabeth Sanchez Arvizu | Student in an Organized Health Care Education/Training Program | 490 N. Grape Stret, Escondido, CA 92025 | 2017-07-25 |
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| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
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| 1013402908 | Ndllj Inc | Substance Abuse Rehabilitation Facility | 21734 Amble Dr, Escondido, CA 92029-4800 | 2018-06-25 |
| 1245766260 | Recovery Solutions LLC | Substance Abuse Rehabilitation Facility | 20710 Elfin Forest Rd, Escondido, CA 92029-3313 | 2017-05-11 |
| 1730535501 | Socal Detox, LLC | Substance Abuse Rehabilitation Facility | 20555 Fortuna Del Sur, Escondido, CA 92029-4507 | 2016-05-10 |
| 1578746103 | North County Serenity House,inc. | Substance Abuse Rehabilitation Facility | 240 S Hickory St Ste 210, Escondido, CA 92025-4357 | 2007-12-05 |
| 1912440645 | Pure Life Recovery, LLC | Substance Abuse Rehabilitation Facility | 19915 Fortuna Del Este, Escondido, CA 92029-5917 | 2016-11-29 |
| 1568818995 | Pamela Gauerke | Substance Abuse Rehabilitation Facility | 1341 N Escondido Blvd, Escondido, CA 92026-2507 | 2016-05-04 |
| 1952761454 | Healthright 360 | Substance Abuse Rehabilitation Facility | 1341 N Escondido Blvd, Escondido, CA 92026-2507 | 2016-02-26 |
| 1013041482 | Healthright 360 | Substance Abuse Rehabilitation Facility | 130 S Fig St, Escondido, CA 92025-4401 | 2007-03-15 |
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| 1467051672 | Spearhead Health Centers, LLC. | Substance Abuse Rehabilitation Facility | 11704 Wilshire Blvd Ste 226, Los Angeles, CA 90025-1504 | 2020-10-19 |
| 1073111613 | A Place To Heal | Substance Abuse Rehabilitation Facility | 14540 Hamlin St Ste H, Van Nuys, CA 91411-4153 | 2020-10-15 |
| 1871191569 | Old Oak Ranch Recovery Center | Substance Abuse Rehabilitation Facility | 19401 Susan Way, Sonora, CA 95370-9266 | 2020-10-14 |
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| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.