Provider Demographics
NPI:1992416556
Name:FRESH START HOME COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:FRESH START HOME COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-632-0811
Mailing Address - Street 1:5168 S MICHIGAN AVE UNIT 4N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3313
Mailing Address - Country:US
Mailing Address - Phone:312-632-0811
Mailing Address - Fax:
Practice Address - Street 1:7003 S NORMAL BLVD APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3064
Practice Address - Country:US
Practice Address - Phone:312-632-0811
Practice Address - Fax:855-267-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based