Organization
FRESH START, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUBY J BLACK M.ED. (CHIEF OPERATING OFFICER)
(216) 431-2554
Entity
Organization
Contact information
Practice address
2415 E 55TH ST, CLEVELAND, OH 44104-1501
(216) 431-2554
(216) 431-4878
Mailing address
2415 E 55TH ST, CLEVELAND, OH 44104-1501
(216) 431-2554
(216) 431-4878
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
06955
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07158
—
OH
Enumeration date
06/22/2006
Last updated
08/22/2020
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