MEDICARE: FRESHLY DONE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1083158398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESHLY DONE, INC

Provider Business Mailing Address
First Line	:	431 E SPRUCE ST
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4015
Country	:	US
Telephone Number	:	727-254-6833
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 E SPRUCE ST
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4015
Country	:	US
Telephone Number	:	727-254-6833
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	SEAN GRUWELL
Credential	:
Telephone Number	:	727-254-6833

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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Directions to “FRESHLY DONE, INC ” Practice Location

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