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General NPI Number Information
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NPI Number | 1174270342
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Entity Type | Organization
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Legal Business Name | A FRESH START ORG INC
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 301 S CHURCH ST STE 153
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-5748
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Country | US
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Telephone | 252-822-1790
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Fax | 252-577-4677
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Provider Business Mailing Address
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Address Line | 301 S CHURCH ST STE 153
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-5748
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Country | US
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Telephone | 252-822-1790
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Fax | 252-577-4677
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Authorized Official
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Title or Position | ADMIN
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Name | ADRIANNE C HALL
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Credential |
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Telephone | 252-822-1790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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