Provider Demographics
NPI:1144067828
Name:FRESH START CARE LLC
Entity type:Organization
Organization Name:FRESH START CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-730-4342
Mailing Address - Street 1:801 PARKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1510
Mailing Address - Country:US
Mailing Address - Phone:916-730-4342
Mailing Address - Fax:916-473-2646
Practice Address - Street 1:801 PARKLIN AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-1510
Practice Address - Country:US
Practice Address - Phone:916-730-4342
Practice Address - Fax:916-473-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility