Healthcare Provider Details

I. General information

NPI: 1295565406
Provider Name (Legal Business Name): FRESH APPROACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 COMMERCIAL CIR STE C
CONCORD CA
94520-8508
US

IV. Provider business mailing address

5060 COMMERCIAL CIR STE C
CONCORD CA
94520-8508
US

V. Phone/Fax

Practice location:
  • Phone: 925-771-2912
  • Fax:
Mailing address:
  • Phone: 925-771-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURA DETAR
Title or Position: EXECUTIVE DIRECTOR
Credential: MPH, CHES
Phone: 925-771-2912