# FRESH START COMMUNITY HEALTH CENTER LLC

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

## Provider details

- **NPI number:** 1689182792
- **Authorized official:** KEESHA S DINKINS (BUSINESS MANAGER)
- **Authorized official phone:** (318) 688-8190

## Contact information

- **Practice address:** 351 W 79TH ST, SHREVEPORT, LA 71106
- **Practice address phone:** (318) 688-8190
- **Mailing address:** 351 W 79TH ST, SHREVEPORT, LA 71106-4819
- **Mailing address phone:** (318) 779-0873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QR0800X | Recovery Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/11/2018
- **Last updated:** 07/24/2019