Provider Demographics
NPI:1215264965
Name:FRESH START LLC
Entity type:Organization
Organization Name:FRESH START LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:3609-784-4186
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-0485
Mailing Address - Country:US
Mailing Address - Phone:360-978-4186
Mailing Address - Fax:360-978-4186
Practice Address - Street 1:1752 STATE HWY 508
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570
Practice Address - Country:US
Practice Address - Phone:360-978-4186
Practice Address - Fax:360-978-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047372251S00000X
WACP00005297251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health