START FRESH ALCOHOL RECOVERY CLINIC NPI 1902113244

NPI Information

NPI: 1902113244
Provider Name: START FRESH ALCOHOL RECOVERY CLINIC

Former Legal Business Name: FRESH START PRIVATE

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
720 NORTH TUSTIN AVE , SUIT #206
SANTA ANA, CA
ZIP 92705
Phone: (714) 541-6100
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START FRESH ALCOHOL RECOVERY CLINIC is an ambulatory surgical clinic center in Santa Ana, CA. START FRESH ALCOHOL RECOVERY CLINIC NPI is 1902113244. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Fresh Start Private.

The provider's business location address is:

720 NORTH TUSTIN AVE , SUIT #206
SANTA ANA, CA
ZIP 92705-606
Phone: (714) 541-6100
Fax: (714) 541-9002

The provider's authorized official is George Nicholas Fallieras .
The authorized official title is Medical Director and has the following contact phone number (714) 541-6100.

The enumeration date for this NPI number is 9/8/2010 and was last updated on 11/15/2013.

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
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

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: 5/5/2024

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