Provider Demographics
NPI:1700024106
Name:FRESH START FAMILY SERVICES
Entity Type:Organization
Organization Name:FRESH START FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:GAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-326-9779
Mailing Address - Street 1:9847 MOUNT MADERA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7518
Mailing Address - Country:US
Mailing Address - Phone:702-326-9779
Mailing Address - Fax:702-586-3162
Practice Address - Street 1:9847 MOUNT MADERA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-7518
Practice Address - Country:US
Practice Address - Phone:702-326-9779
Practice Address - Fax:702-586-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health