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General NPI Number Information
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NPI Number | 1730578329
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Entity Type | Organization
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Legal Business Name | FRESH START HEALTH CARE SERVICES,INC
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 215 W JEFFERSON ST STE E
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City | QUINCY
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State | FL
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Zip | 32351-2356
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Country | US
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Telephone | 850-556-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 182 SPARKLEBERRY BLVD
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City | QUINCY
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State | FL
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Zip | 32351-7282
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Country | US
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Telephone | 850-556-2303
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY A MATHEWS
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Credential | RN
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Telephone | 850-556-2303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN9368071
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License Number State | FL
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