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General NPI Number Information
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NPI Number | 1811417488
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Entity Type | Organization
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Legal Business Name | START FRESH ACADEMY
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 06/23/2017
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Provider Practice Location Address
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Address Line | 518 NORTH AVE STE C
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City | ROCK HILL
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State | SC
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Zip | 29732-3050
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Country | US
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Telephone | 980-349-7981
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 PAMPAS CIR
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City | ROCK HILL
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State | SC
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Zip | 29732-3853
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Country | US
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Telephone | 980-349-7981
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARCO TERRELL HUTCHINSON
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Credential | MBA
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Telephone | 980-349-7981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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