Provider Demographics
NPI:1669252995
Name:FRESH START HEALTH PSC
Entity type:Organization
Organization Name:FRESH START HEALTH PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERREL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-296-6666
Mailing Address - Street 1:207 PLUMMERS LN
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-7683
Mailing Address - Country:US
Mailing Address - Phone:606-225-8200
Mailing Address - Fax:888-606-7354
Practice Address - Street 1:207 PLUMMERS LN
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-7683
Practice Address - Country:US
Practice Address - Phone:606-225-8200
Practice Address - Fax:888-606-7354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESH START HEALTH PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health