Provider Demographics
NPI:1518309665
Name:START FRESH RECOVERY SOUTHWEST
Entity Type:Organization
Organization Name:START FRESH RECOVERY SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDICINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-630-6200
Mailing Address - Street 1:7150 E CAMELBACK RD
Mailing Address - Street 2:SUITE 444
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1200
Mailing Address - Country:US
Mailing Address - Phone:847-630-6200
Mailing Address - Fax:
Practice Address - Street 1:7150 E CAMELBACK RD
Practice Address - Street 2:SUITE 444
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1200
Practice Address - Country:US
Practice Address - Phone:847-630-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty