Provider Demographics
NPI:1730578329
Name:FRESH START HEALTH CARE SERVICES,INC
Entity type:Organization
Organization Name:FRESH START HEALTH CARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:850-556-2303
Mailing Address - Street 1:182 SPARKLEBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-7282
Mailing Address - Country:US
Mailing Address - Phone:850-556-2303
Mailing Address - Fax:
Practice Address - Street 1:215 W JEFFERSON ST STE E
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2356
Practice Address - Country:US
Practice Address - Phone:850-556-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9368071251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care