MEDICARE: A FRESH START LLC

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	:	1548702947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FRESH START LLC

Provider Business Mailing Address
First Line	:	7637 HULL STREET RD STE 101
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7637 HULL STREET RD STE 101
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6437
Country	:	US
Telephone Number	:	804-306-6707
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RONEECE WALKER
Credential	:
Telephone Number	:	804-306-6707

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	11/16/2016

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Directions to “A FRESH START LLC ” Practice Location

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