Provider Demographics
NPI:1477206886
Name:FRESH START HEALTH PSC
Entity Type:Organization
Organization Name:FRESH START HEALTH PSC
Other - Org Name:FRESH START HEALTH CENTERS GRAYSON
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERREL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-922-2895
Mailing Address - Street 1:207 N CAROL MALONE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1566
Mailing Address - Country:US
Mailing Address - Phone:606-225-8200
Mailing Address - Fax:
Practice Address - Street 1:207 N CAROL MALONE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1566
Practice Address - Country:US
Practice Address - Phone:606-225-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health