Healthcare Provider Details

I. General information

NPI: 1487031449
Provider Name (Legal Business Name): A FRESH START ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CHURCH ST STE 153
ROCKY MOUNT NC
27804-5748
US

IV. Provider business mailing address

301 S CHURCH ST
ROCKY MOUNT NC
27804-5755
US

V. Phone/Fax

Practice location:
  • Phone: 282-822-1790
  • Fax: 252-577-4677
Mailing address:
  • Phone: 282-822-1790
  • Fax: 252-577-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ADRIANNE CHRISTINA HALL SPRUILL
Title or Position: ADMIN
Credential:
Phone: 252-822-1790