Provider Demographics
NPI:1235368440
Name:A FRESH START COMMUNITY DEVELOPMENT CORPORATION, INC
Entity Type:Organization
Organization Name:A FRESH START COMMUNITY DEVELOPMENT CORPORATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-330-3840
Mailing Address - Street 1:521 STADIUM DR
Mailing Address - Street 2:P.O. BOX 61
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6541
Mailing Address - Country:US
Mailing Address - Phone:919-330-3840
Mailing Address - Fax:
Practice Address - Street 1:521 STADIUM DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6541
Practice Address - Country:US
Practice Address - Phone:919-330-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency