Healthcare Provider Details

I. General information

NPI: 1902619281
Provider Name (Legal Business Name): FRESH START RECOVERY HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HIGH ST
ATWATER CA
95301-4122
US

IV. Provider business mailing address

543 SPUR CT
MERCED CA
95341-5466
US

V. Phone/Fax

Practice location:
  • Phone: 209-631-9093
  • Fax:
Mailing address:
  • Phone: 209-631-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SARAH MURRAY
Title or Position: SECRETARY
Credential:
Phone: 209-631-9093