Provider Demographics
NPI:1588995542
Name:FRESH START FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:FRESH START FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSHAUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-236-5680
Mailing Address - Street 1:1566 UNION RD STE B
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5301
Mailing Address - Country:US
Mailing Address - Phone:704-236-5680
Mailing Address - Fax:888-340-4417
Practice Address - Street 1:1566 UNION RD STE B
Practice Address - Street 2:SUITE 6
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5301
Practice Address - Country:US
Practice Address - Phone:704-236-5680
Practice Address - Fax:888-340-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children