Organization
FRESH START PRIVATE FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY JON JACKOBOICE (CEO)
(239) 591-6240
Entity
Organization
Contact information
Practice address
1415 PANTHER LN, NAPLES, FL 34109-7874
(239) 591-6240
Mailing address
1415 PANTHER LN, NAPLES, FL 34109-7874
(239) 591-6240
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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