Provider Demographics
NPI:1043381106
Name:FRESH NEW START
Entity Type:Organization
Organization Name:FRESH NEW START
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WETENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-701-1934
Mailing Address - Street 1:1934 NW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-8766
Mailing Address - Country:US
Mailing Address - Phone:260-701-1934
Mailing Address - Fax:260-724-2511
Practice Address - Street 1:1934 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-8766
Practice Address - Country:US
Practice Address - Phone:260-701-1934
Practice Address - Fax:260-724-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization