Provider Demographics
NPI:1093832420
Name:FRESH START SERVICES
Entity Type:Organization
Organization Name:FRESH START SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-645-8888
Mailing Address - Street 1:7 N LAFAYETTE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5400
Mailing Address - Country:US
Mailing Address - Phone:704-487-5705
Mailing Address - Fax:704-487-5707
Practice Address - Street 1:7 N LAFAYETTE ST STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5400
Practice Address - Country:US
Practice Address - Phone:704-487-5705
Practice Address - Fax:704-487-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization