MEDICARE: FRESH START SERVICES, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760609929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESH START SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 570924
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89157-0924
Country	:	US
Telephone Number	:	702-631-3319
Fax Number	:	702-631-0051

Provider Business Practice Location Address
First Line	:	2521 APRICOT LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3555
Country	:	US
Telephone Number	:	702-631-3319
Fax Number	:	702-631-0051

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GIRMA ZAID
Credential	:	LCSW
Telephone Number	:	702-631-3319

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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