Healthcare Provider Details

I. General information

NPI: 1588507461
Provider Name (Legal Business Name): FRESH START USA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44709 BEECH AVE
LANCASTER CA
93534-3206
US

IV. Provider business mailing address

44709 BEECH AVE # A
LANCASTER CA
93534-3206
US

V. Phone/Fax

Practice location:
  • Phone: 888-487-5705
  • Fax: 661-206-2428
Mailing address:
  • Phone: 888-487-5705
  • Fax: 661-206-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SHENELL A ADAMS
Title or Position: ADMINISTRATOR
Credential: CPLC, MPA
Phone: 888-487-5705