Provider Demographics
NPI:1225689243
Name:FRESH BEGINNINGS SERVICES, LLC
Entity Type:Organization
Organization Name:FRESH BEGINNINGS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WYNNETTE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-530-4192
Mailing Address - Street 1:PO BOX 40292
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77240-0292
Mailing Address - Country:US
Mailing Address - Phone:713-530-4192
Mailing Address - Fax:
Practice Address - Street 1:7863 LUMBER JACK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-1740
Practice Address - Country:US
Practice Address - Phone:713-530-4192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347C00000XMedicaid