Provider Demographics
NPI:1093350951
Name:FRESH START BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:FRESH START BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-364-0429
Mailing Address - Street 1:2731 DELCANE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7219
Mailing Address - Country:US
Mailing Address - Phone:614-364-0429
Mailing Address - Fax:
Practice Address - Street 1:1909 S ALEX RD
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-4001
Practice Address - Country:US
Practice Address - Phone:614-364-0429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service