Provider Demographics
NPI:1962802462
Name:A FRESH START RECOVERY SERVICES
Entity type:Organization
Organization Name:A FRESH START RECOVERY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:LCP, ACADC, NCC
Authorized Official - Phone:208-459-9222
Mailing Address - Street 1:1123 BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3835
Mailing Address - Country:US
Mailing Address - Phone:208-459-9222
Mailing Address - Fax:
Practice Address - Street 1:1123 BLAINE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3835
Practice Address - Country:US
Practice Address - Phone:208-459-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A FRESH START RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder