Provider Demographics
NPI:1376326967
Name:FRESH START RECOVERY SVCS
Entity Type:Organization
Organization Name:FRESH START RECOVERY SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC
Authorized Official - Phone:949-734-9254
Mailing Address - Street 1:204 E 17TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7300
Mailing Address - Country:US
Mailing Address - Phone:949-734-9254
Mailing Address - Fax:
Practice Address - Street 1:204 E 17TH ST STE 203
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7300
Practice Address - Country:US
Practice Address - Phone:949-734-9254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)