Healthcare Provider Details

I. General information

NPI: 1235376526
Provider Name (Legal Business Name): FRESH START SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 APRICOT LN
LAS VEGAS NV
89108-3555
US

IV. Provider business mailing address

PO BOX 570924
LAS VEGAS NV
89157-0924
US

V. Phone/Fax

Practice location:
  • Phone: 702-631-3319
  • Fax: 702-631-0051
Mailing address:
  • Phone: 702-631-3319
  • Fax: 702-631-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number5095-C
License Number StateNV

VIII. Authorized Official

Name: MR. GIRMA ZAID
Title or Position: EXECUTIVE DIR.
Credential: MSW
Phone: 702-631-3319