NPIMap

Organization Active NPI

Fresh Start Recovery Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gaithersburg, MD
National Provider Identifier
1144809088
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FRESH START RECOVERY CENTER LLC
Practice address
15886 Gaither Dr Ste B
Gaithersburg, MD 20877-1404
Phone
(844) 814-6862
NPI assigned
Apr 7, 2021
Organization subpart
Yes
Parent organization
FRESH START RECOVERY CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessie Costley
Title
Licensing Specialist
Phone
(410) 807-8471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

15886 Gaither Dr Ste B
Gaithersburg, MD 20877-1404

Mailing address

15886 Gaither Dr Ste B
Gaithersburg, MD 20877-1404
Phone (844) 814-6862

National Provider Directory

National Provider Directory
Tax ID family
Fresh Start Recovery Lab4 organizations share this tax ID, including this one
Part of
Fresh Start Recovery Lab

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1144809088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15886 GAITHER DR STE B",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771404",
            "telephone_number": "844-814-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15886 GAITHER DR STE B",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771404",
            "telephone_number": "844-814-6862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START RECOVERY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESH START RECOVERY CENTER LLC",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "COSTLEY",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "LICENSING SPECIALIST",
        "authorized_official_telephone_number": "410-807-8471"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.