Provider Demographics
NPI:1033675608
Name:FRESHSTART RECOVERY LLC
Entity type:Organization
Organization Name:FRESHSTART RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC, LPC, NCC, CCBT
Authorized Official - Phone:602-299-3545
Mailing Address - Street 1:2913 W DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6353
Mailing Address - Country:US
Mailing Address - Phone:480-343-0086
Mailing Address - Fax:
Practice Address - Street 1:2913 W DUNBAR DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6353
Practice Address - Country:US
Practice Address - Phone:480-343-0086
Practice Address - Fax:602-975-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness