Provider Demographics
NPI:1477998631
Name:FRESH START CDS
Entity Type:Organization
Organization Name:FRESH START CDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-388-0801
Mailing Address - Street 1:2115 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4309
Mailing Address - Country:US
Mailing Address - Phone:314-388-0801
Mailing Address - Fax:314-388-0885
Practice Address - Street 1:2115 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4309
Practice Address - Country:US
Practice Address - Phone:314-388-0801
Practice Address - Fax:314-388-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESH START DAY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care