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General NPI Number Information
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NPI Number | 1093832420
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Entity Type | Organization
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Legal Business Name | FRESH START SERVICES
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 N LAFAYETTE ST STE 2
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City | SHELBY
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State | NC
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Zip | 28150-5400
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Country | US
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Telephone | 704-487-5705
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Fax | 704-487-5707
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Provider Business Mailing Address
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Address Line | 7 N LAFAYETTE ST STE 2
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City | SHELBY
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State | NC
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Zip | 28150-5400
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Country | US
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Telephone | 704-487-5705
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Fax | 704-487-5707
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICK TAYLOR
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Credential |
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Telephone | 704-645-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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