Provider Demographics
NPI:1811168651
Name:FRESH START COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:FRESH START COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:SR
Authorized Official - Credentials:BS
Authorized Official - Phone:864-621-4047
Mailing Address - Street 1:PO BOX 4440
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-4440
Mailing Address - Country:US
Mailing Address - Phone:888-603-8293
Mailing Address - Fax:
Practice Address - Street 1:1484 PEARMAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2000
Practice Address - Country:US
Practice Address - Phone:888-603-8293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency