MEDICARE: START FRESH RECOVERY SOUTHWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1518309665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	START FRESH RECOVERY SOUTHWEST

Provider Business Mailing Address
First Line	:	7150 E CAMELBACK RD
Second Line	:	SUITE 444
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1200
Country	:	US
Telephone Number	:	847-630-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 E CAMELBACK RD
Second Line	:	SUITE 444
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1200
Country	:	US
Telephone Number	:	847-630-6200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOAN PEDICINI
Credential	:
Telephone Number	:	847-630-6200

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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Directions to “START FRESH RECOVERY SOUTHWEST ” Practice Location

Language	Start Address	Practice Location

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