Organization
FRESH START BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL BANGURA (COE/ADMINSTRATION)
(623) 216-5759
Entity
Organization
Contact information
Practice address
5422 W THUNDERBIRD RD, GLENDALE, AZ 85306-4700
(623) 216-5759
Mailing address
5422 W THUNDERBIRD RD, GLENDALE, AZ 85306-4700
(623) 216-5759
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
10/21/2022
Last updated
07/02/2024
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