Organization
A FRESH START RECOVERY HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REEIYAINA GRIFFIN (AGENT)
(414) 815-0505
Entity
Organization
Contact information
Practice address
3505 W NORTH AVE, MILWAUKEE, WI 53208-1415
(414) 600-9947
Mailing address
PO BOX 12773, MILWAUKEE, WI 53212-0773
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25XXXXXXXX
PRIMARY SPECIALITY
WI
Enumeration date
02/16/2022
Last updated
02/16/2022
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