# START FRESH CENTRAL VALLEY RECOVERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164830501
- **Authorized official:** ROBERT GRAHAM M.D. (SUPERVISING PHYSICIAN)
- **Authorized official phone:** (559) 202-3830

## Contact information

- **Practice address:** 6073 N 1ST ST STE 102, FRESNO, CA 93710-5444
- **Practice address phone:** (559) 202-3830
- **Mailing address:** PO BOX 25042, FRESNO, CA 93729-5042
- **Mailing address phone:** (559) 438-1245
- **Mailing address fax:** (559) 892-4500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/29/2014
- **Last updated:** 07/29/2014