NPIMap

Organization Active NPI

Fresh Start Recovery Center LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gaithersburg, MD
National Provider Identifier
1295272482
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
D0046457 Issued in MD
Legal business name
FRESH START RECOVERY CENTER LLC
Practice address
15886 Gaither Dr
Suite B
Gaithersburg, MD 20877-1404
Phone
(301) 300-3696
Fax
(954) 298-4039
NPI assigned
Jan 25, 2017
Last updated
Apr 7, 2021By the provider in NPPES
Organization subpart
No

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
Credentialing Specialist
Phone
(443) 839-6928

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X D0046457 MD Primary

Addresses

Primary practice location

15886 Gaither Dr
Suite B
Gaithersburg, MD 20877-1404

Mailing address

15886 Gaither Dr
Suite B
Gaithersburg, MD 20877-1404
Phone (301) 300-3696

National Provider Directory

National Provider Directory
Tax ID family
Fresh Start Recovery4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1295272482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15886 GAITHER DR",
            "address_2": "SUITE B",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771404",
            "telephone_number": "301-300-3696",
            "fax_number": "954-298-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15886 GAITHER DR",
            "address_2": "SUITE B",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771404",
            "telephone_number": "301-300-3696",
            "fax_number": "954-298-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "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": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "443-839-6928"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MD",
            "license": "D0046457",
            "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.