Provider Demographics
NPI:1700607918
Name:FRESH START HEALTH PSC
Entity type:Organization
Organization Name:FRESH START HEALTH PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERREL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-296-6666
Mailing Address - Street 1:150 NEWTOWNE SQ
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-2406
Mailing Address - Country:US
Mailing Address - Phone:606-225-8200
Mailing Address - Fax:888-606-7354
Practice Address - Street 1:150 NEWTOWNE SQ
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-2406
Practice Address - Country:US
Practice Address - Phone:606-225-8200
Practice Address - Fax:888-606-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health