NPIMap

Organization Active NPI

Fresh Start Residential Services Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1669507315
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL 092 480 Issued in NC
Legal business name
FRESH START RESIDENTIAL SERVICES INC
Practice address
5817 Old Forge Cir
Raleigh, NC 27609-4035
Phone
(919) 790-7869
Fax
(919) 790-7864
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mr. Michael Parks
Title
President
Phone
(919) 790-7869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL 092 480 NC Primary

Addresses

Primary practice location

5817 Old Forge Cir
Raleigh, NC 27609-4035

Mailing address

2411 E Millbrook Rd Ste 114
Raleigh, NC 27604-2800
Phone (919) 790-7869

National Provider Directory

National Provider Directory
Tax ID family
Fresh Start Residential Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1669507315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 E MILLBROOK RD STE 114",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276042800",
            "telephone_number": "919-790-7869",
            "fax_number": "919-790-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5817 OLD FORGE CIR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094035",
            "telephone_number": "919-790-7869",
            "fax_number": "919-790-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START RESIDENTIAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-790-7869",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL 092 480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.