Organization
FRESH START PRIVATE MIDWEST LLC
Active
Other names
Start Fresh Alcohol Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
GRIFFITH F EVANS M.D. (MEDICAL DIRECTOR)
(402) 884-1221
Entity
Organization
Contact information
Practice address
2827 S 88TH ST, OMAHA, NE 68124-3056
(402) 884-1221
(402) 884-1335
Mailing address
2827 S 88TH ST, OMAHA, NE 68124-3056
(402) 884-1221
(402) 884-1335
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
207LPZ900X
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508729194
—
NE
Enumeration date
06/18/2015
Last updated
06/18/2015
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