| Fresh Start Private Florida | |
|
1415 Panther Ln Naples FL 34109-7874 | |
| (239) 591-6240 | |
| Not Available |
| Full Name | Fresh Start Private Florida |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 1415 Panther Ln, Naples, Florida |
| Authorized Official Name and Position | Timothy Jon Jackoboice (CEO) |
| Authorized Official Contact | 2395916240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Start Private Florida 1415 Panther Ln Naples FL 34109-7874 Ph: (239) 591-6240 | Fresh Start Private Florida 1415 Panther Ln Naples FL 34109-7874 Ph: (239) 591-6240 |
| NPI Number | 1003166307 |
|---|---|
| Provider Enumeration Date | 09/13/2012 |
| Last Update Date | 09/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003166307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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