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General NPI Number Information
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NPI Number | 1669525465
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Entity Type | Organization
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Legal Business Name | FRESH START SERVICES, INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1102 EDNA ST
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City | SHELBY
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State | NC
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Zip | 28152-8970
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Country | US
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Telephone | 704-645-8888
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Fax | 704-645-8900
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Provider Business Mailing Address
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Address Line | 421 N LONG ST P.O.BOX 4084
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City | SALISBURY
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State | NC
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Zip | 28144-4428
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Country | US
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Telephone | 704-645-8888
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Fax | 104-645-8900
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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 | 704-309-3758
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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 | MHL-023-115
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License Number State | NC
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