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Organization

FRESH START RECOVERY CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 839-6928
Entity
Organization

Contact information

Practice address
15886 GAITHER DR, SUITE B, GAITHERSBURG, MD 20877-1404
(301) 300-3696
(954) 298-4039
Mailing address
15886 GAITHER DR, SUITE B, GAITHERSBURG, MD 20877-1404
(301) 300-3696
(954) 298-4039

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
D0046457
MD

Other

Enumeration date
01/25/2017
Last updated
04/07/2021
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