Fresh Start Private Florida
Clinic/Center, Rehabilitation, Substance Use Disorder in Naples, FL. Organization (NPI-2).
NPI number1003166307
StatusActive
Last updated in NPPESSep 13, 2012
Details
- NPI
- 1003166307
- Entity type
- Organization (NPI-2)
- Legal business name
- Fresh Start Private Florida
- Organization subpart
- No
- Enumeration date
- Sep 13, 2012
- Last updated
- Sep 13, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | Yes |
| 251S00000X | Community/Behavioral Health | – | – |
Practice location
1415 Panther LnNaples, FL 34109-7874
Phone 239-591-6240
Mailing address
1415 Panther LnNaples, FL 34109-7874
Phone 239-591-6240
Authorized official
Timothy Jon Jackoboice
Ceo
2395916240
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