| Fresh Start Llc | |
|
1752 State Hwy 508 Onalaska WA 98570 | |
| (360) 978-4186 | |
| (360) 978-4186 |
| Full Name | Fresh Start Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1752 State Hwy 508, Onalaska, Washington |
| Authorized Official Name and Position | Larry Meade (OWNER/OPERATOR) |
| Authorized Official Contact | 36097844186 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Start Llc Po Box 485 Onalaska WA 98570-0485 Ph: (360) 978-4186 | Fresh Start Llc 1752 State Hwy 508 Onalaska WA 98570 Ph: (360) 978-4186 |
| NPI Number | 1215264965 |
|---|---|
| Provider Enumeration Date | 11/17/2009 |
| Last Update Date | 11/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215264965 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | RC00047372 (Washington) | Primary |
| 251S00000X | Community/behavioral Health | CP00005297 (Washington) | Secondary |