Organization
FRESH START RESIDENTIAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL PARKS (PRESIDENT)
(919) 790-7869
Entity
Organization
Contact information
Practice address
5039 SEDGEWICK DR APT D, RALEIGH, NC 27616-4576
(919) 790-7869
(919) 790-7864
Mailing address
2411 E MILLBROOK RD STE 114, RALEIGH, NC 27604-2800
(919) 790-7869
(919) 790-7864
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL 092 449
NC
Other
Enumeration date
02/22/2007
Last updated
08/22/2020
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