Healthcare Provider Details

I. General information

NPI: 1295469088
Provider Name (Legal Business Name): FRESH START INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HENDERSON AVE APT 1313
HOUSTON TX
77058-3809
US

IV. Provider business mailing address

900 HENDERSON AVE APT 1313
HOUSTON TX
77058-3809
US

V. Phone/Fax

Practice location:
  • Phone: 704-492-1631
  • Fax:
Mailing address:
  • Phone: 704-492-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ADEDAYO WEBB
Title or Position: PRESIDENT
Credential:
Phone: 704-492-1631