Healthcare Provider Details

I. General information

NPI: 1376915231
Provider Name (Legal Business Name): FRESH START OF CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N DAISY AVE
SANTA ANA CA
92703-2854
US

IV. Provider business mailing address

503 N DAISY AVE
SANTA ANA CA
92703-2854
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-2601
  • Fax:
Mailing address:
  • Phone: 714-558-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300349AP
License Number StateCA

VIII. Authorized Official

Name: LINDSEY CENTANNI
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 714-558-2600