Provider Demographics
NPI:1225237621
Name:FRESH START RECOVERY COALITION, INC
Entity Type:Organization
Organization Name:FRESH START RECOVERY COALITION, INC
Other - Org Name:INDIGO BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAMION
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-388-9300
Mailing Address - Street 1:214 COMMERCIAL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6716
Mailing Address - Country:US
Mailing Address - Phone:781-388-9300
Mailing Address - Fax:781-388-9325
Practice Address - Street 1:214 COMMERCIAL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6716
Practice Address - Country:US
Practice Address - Phone:781-388-9300
Practice Address - Fax:781-388-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty