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General NPI Number Information
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NPI Number | 1477998631
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Entity Type | Organization
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Legal Business Name | FRESH START CDS
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 2115 CHAMBERS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-4309
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Country | US
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Telephone | 314-388-0801
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Fax | 314-388-0885
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Provider Business Mailing Address
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Address Line | 2115 CHAMBERS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-4309
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Country | US
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Telephone | 314-388-0801
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Fax | 314-388-0885
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Authorized Official
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Title or Position | CEO
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Name | DR. CALVIN SCOTT
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Credential | PH.D.
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Telephone | 314-388-0801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | MO
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