Provider Demographics
NPI:1104466697
Name:FRESHSTART RECOVERY LLC
Entity type:Organization
Organization Name:FRESHSTART RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANOVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-343-0086
Mailing Address - Street 1:28518 N 26TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-3726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2914 W DONNER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6343
Practice Address - Country:US
Practice Address - Phone:480-343-0086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESHSTART RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness