Organization
FRESH START RECOVERY SVCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID WAYNE PARKER LAADC (CEO)
(949) 734-9254
Entity
Organization
Contact information
Practice address
204 E 17TH ST STE 203, COSTA MESA, CA 92627-7300
(949) 734-9254
Mailing address
204 E 17TH ST STE 203, COSTA MESA, CA 92627-7300
(949) 734-9254
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
08/16/2023
Last updated
07/22/2024
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