Healthcare Provider Details

I. General information

NPI: 1417771320
Provider Name (Legal Business Name): FRESH START HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 PAINTER AVE STE 1
WHITTIER CA
90602-2469
US

IV. Provider business mailing address

7901 PAINTER AVE STE 1
WHITTIER CA
90602-2469
US

V. Phone/Fax

Practice location:
  • Phone: 562-800-6922
  • Fax: 562-800-3214
Mailing address:
  • Phone: 562-800-6922
  • Fax: 562-800-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIO RIVAS
Title or Position: OWNER
Credential:
Phone: 562-800-6922