Provider Demographics
NPI:1609402437
Name:START FRESH FOUNDATION INC
Entity Type:Organization
Organization Name:START FRESH FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:813-957-2239
Mailing Address - Street 1:135 N MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4419
Mailing Address - Country:US
Mailing Address - Phone:813-489-4546
Mailing Address - Fax:813-381-5140
Practice Address - Street 1:135 N MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4419
Practice Address - Country:US
Practice Address - Phone:813-489-4546
Practice Address - Fax:813-381-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCMS100611OtherFLORIDA CERTIFICATION BOARD