Provider Demographics
NPI:1518229285
Name:FRESH START COUNSELING CENTER
Entity Type:Organization
Organization Name:FRESH START COUNSELING CENTER
Other - Org Name:SACRED GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-351-1100
Mailing Address - Street 1:1720 W FLORIST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3800
Mailing Address - Country:US
Mailing Address - Phone:414-351-1100
Mailing Address - Fax:414-351-0436
Practice Address - Street 1:1720 W FLORIST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3800
Practice Address - Country:US
Practice Address - Phone:414-351-1100
Practice Address - Fax:414-351-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care