FRESH START REHAB LLC NPI 1033093158

NPI Information

  • NPI: 1033093158
  • Provider Name: FRESH START REHAB LLC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • CLIA Number: 34D2328997
  • Address: 624 S FAYETTEVILLE ST STE C
    ASHEBORO, NC
    ZIP 27203
  • Phone: (743) 224-7107

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NPI Details

FRESH START REHAB LLC is a rehabilitation and substance use disorder clinic center in Asheboro, NC. FRESH START REHAB LLC NPI is 1033093158. The provider is registered as an organization entity type.

The provider's business location address is:

624 S FAYETTEVILLE ST STE C
ASHEBORO, NC
ZIP 27203-582
Phone: (743) 224-7107

The provider's authorized official is Jariksa Menjivar .
The authorized official title is Owner and has the following contact phone number (743) 224-7107.

The CLIA number assigned to this NPI record is 34D2328997 - other - saiop with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/1/2025 and was last updated on 8/1/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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