Provider Demographics
NPI:1427586296
Name:PROJECT FRESH START INC.
Entity Type:Organization
Organization Name:PROJECT FRESH START INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELS
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-399-3307
Mailing Address - Street 1:PO BOX 7367
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-0367
Mailing Address - Country:US
Mailing Address - Phone:651-399-3307
Mailing Address - Fax:
Practice Address - Street 1:2854 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1324
Practice Address - Country:US
Practice Address - Phone:612-354-7904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4593103TC0700X
MN23792104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty