Provider Demographics
NPI:1790853646
Name:FRESH START YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:FRESH START YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEOEXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LHEUREUX
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPA
Authorized Official - Phone:704-226-2469
Mailing Address - Street 1:429 BOSTIC SUNSHINE HWY
Mailing Address - Street 2:
Mailing Address - City:BOSTIC
Mailing Address - State:NC
Mailing Address - Zip Code:28018-9775
Mailing Address - Country:US
Mailing Address - Phone:704-226-2469
Mailing Address - Fax:704-290-2399
Practice Address - Street 1:429 BOSTIC SUNSHINE HWY
Practice Address - Street 2:
Practice Address - City:BOSTIC
Practice Address - State:NC
Practice Address - Zip Code:28018-9775
Practice Address - Country:US
Practice Address - Phone:704-226-2469
Practice Address - Fax:704-290-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC081067322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604020Medicaid