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General NPI Number Information
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NPI Number | 1518851864
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Entity Type | Organization
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Legal Business Name | FRESH START MEDICAL SERVICES
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 10150 W NATIONAL AVE STE 202
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City | WEST ALLIS
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State | WI
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Zip | 53227-2145
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Country | US
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Telephone | 414-315-7227
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Fax | 414-553-9119
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Provider Business Mailing Address
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Address Line | PO BOX 5115
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City | MILWAUKEE
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State | WI
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Zip | 53205-0115
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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 | MEMBER OFFICE REP
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Name | KATORI LEWIS
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Credential |
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Telephone | 414-315-7227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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