Provider Demographics
NPI:1275768947
Name:FRESH START COMMUNITY SERVICES
Entity Type:Organization
Organization Name:FRESH START COMMUNITY SERVICES
Other - Org Name:FRESH START COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-206-6825
Mailing Address - Street 1:7206 N 55TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1975
Mailing Address - Country:US
Mailing Address - Phone:623-206-6825
Mailing Address - Fax:623-206-6825
Practice Address - Street 1:7206 N 55TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1975
Practice Address - Country:US
Practice Address - Phone:623-206-6825
Practice Address - Fax:623-206-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility