Healthcare Provider Details

I. General information

NPI: 1235368440
Provider Name (Legal Business Name): A FRESH START COMMUNITY DEVELOPMENT CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 STADIUM DR
GOLDSBORO NC
27530-6541
US

IV. Provider business mailing address

521 STADIUM DR P.O. BOX 61
GOLDSBORO NC
27530-6541
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-3840
  • Fax:
Mailing address:
  • Phone: 919-330-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE BRYANT
Title or Position: CEO/OWNER
Credential:
Phone: 919-330-3840