Organization
FRESH START RECOVERY LAB
Active
Parent organization
FRESH START RECOVERY CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRESH START RECOVERY CENTER
Authorized official
CATHY PICILLO (OFFICE MANAGER)
(954) 234-2469
Entity
Organization
Contact information
Practice address
15886 GAITHER DR, GAITHERSBURG, MD 20877-1404
(954) 234-2469
(954) 204-0464
Mailing address
15886 GAITHER DR, GAITHERSBURG, MD 20877-1404
(954) 234-2469
(954) 204-0464
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
21D2127826
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21D2127826
CENTER MEDICARE MEDICAID
MD
Enumeration date
04/19/2017
Last updated
04/19/2017
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