Provider Demographics
NPI:1588263453
Name:FRESH START BEHAVIORAL HEALTH INC
Entity type:Organization
Organization Name:FRESH START BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:614-364-0429
Mailing Address - Street 1:6929 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2563
Mailing Address - Country:US
Mailing Address - Phone:937-247-9102
Mailing Address - Fax:
Practice Address - Street 1:8015 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2250
Practice Address - Country:US
Practice Address - Phone:937-247-9102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESH START BEHAVIORAL HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-22
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health