Healthcare Provider Details

I. General information

NPI: 1235175480
Provider Name (Legal Business Name): FRESH START, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E 55TH ST
CLEVELAND OH
44104-1501
US

IV. Provider business mailing address

2415 E 55TH ST
CLEVELAND OH
44104-1501
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-2554
  • Fax: 216-431-4878
Mailing address:
  • Phone: 216-431-2554
  • Fax: 216-431-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number06955
License Number StateOH

VIII. Authorized Official

Name: MS. RUBY J BLACK
Title or Position: CHIEF OPERATING OFFICER
Credential: M.ED.
Phone: 216-431-2554