1811417488 NPI number — START FRESH ACADEMY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811417488 NPI number — START FRESH ACADEMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
START FRESH ACADEMY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811417488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 PAMPAS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-3853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-349-7981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 NORTH AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-349-7981
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUTCHINSON
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
TERRELL
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
980-349-7981

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)