Organization
FRESH START CLUBHOUSE, INC.
Active
Other names
Fresh Start
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WEBB LUCAS COTA (EXECUTIVE DIRECTOR)
(734) 929-9992
Entity
Organization
Contact information
Practice address
211 E MICHIGAN AVE UPPR, YPSILANTI, MI 48198-5677
(734) 929-9992
Mailing address
211 E MICHIGAN AVE UPPR, YPSILANTI, MI 48198-5677
(734) 929-9992
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/06/2022
Last updated
09/23/2024
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