Organization
FRESH START HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUKELISO DEMADEMA (OWNER)
(312) 823-9296
Entity
Organization
Contact information
Practice address
5504 41ST AVE S, MINNEAPOLIS, MN 55417-2216
(312) 823-9296
Mailing address
5504 41ST AVE S, MINNEAPOLIS, MN 55417-2216
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/22/2025
Last updated
07/22/2025
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