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General NPI Number Information
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NPI Number | 1083379085
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Entity Type | Organization
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Legal Business Name | FRESH START TODAY INC
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 701 WICKER ST
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City | GREENSBORO
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State | NC
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Zip | 27403-1923
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Country | US
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Telephone | 336-303-5844
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Fax |
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Provider Business Mailing Address
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Address Line | 2212 GLENSIDE DR
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City | GREENSBORO
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State | NC
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Zip | 27405-1614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA JOHNSON
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Credential |
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Telephone | 336-303-5844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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