Organization
FRESH START DIALYSIS SPA TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAHISHA B. BROOKS (PRESIDENT & CEO)
(240) 606-7828
Entity
Organization
Contact information
Practice address
1101 MERCANTILE LN, LARGO, MD 20774-5360
(240) 606-7828
Mailing address
719 STREAMSIDE DR, BOWIE, MD 20721-1803
(240) 606-7828
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133VN1005X
Renal Nutrition Registered Dietitian
—
—
172A00000X
Driver
—
—
225700000X
Massage Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/20/2009
Last updated
08/20/2009
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