1689920282 NPI number — FRESH BEGINNING, INC.

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 1689920282 NPI number — FRESH BEGINNING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRESH BEGINNING, INC.
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:
1689920282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 W 11TH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95376-3906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-830-7400
Provider Business Mailing Address Fax Number:
209-833-8386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1852 W. 11TH STREET
Provider Second Line Business Practice Location Address:
#699
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-830-7400
Provider Business Practice Location Address Fax Number:
209-833-8386
Provider Enumeration Date:
08/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
209-830-7400

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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