START FRESH ALCOHOL RECOVERY CLINIC, INC (NPI# 1497150007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497150007 |
| Entity Type | Organization |
| Organization Name | START FRESH ALCOHOL RECOVERY CLINIC, INC |
| Other Organization Name | START FRESH RECOVERY LAS VEGAS |
| Practice Address |
501 S Rancho Dr Ste H50 Las Vegas NV 89106-4828 |
| Practice Telephone | 7029190000 |
| Practice Fax Number | 7024769411 |
| Mailing Telephone | 7029190000 |
| Mailing Fax Number | 7024769411 |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2014-10-24 |
| Authorized Official Name | GEORGE N FALLIERAS (PRESIDENT) |
| Authorized Official Telephone | 7029190000 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0800X |
Clinic/Center Specialization: Recovery Care |
Ambulatory Health Care Facilities | ||
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
15522 | NV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | STATE LICENSE | 15522 | 01 |
| Other Name | Type Code |
|---|---|
| Start Fresh Recovery Las Vegas | Doing Business As Name - Organization |
| Street Address |
501 S RANCHO DR STE H50 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89106-4828 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417555772 | Graciela Miranda Cocorpio | Technician | 820 Rancho Ln Suite #40, Las Vegas, NV 89106 | 2020-10-09 |
| 1679101679 | A Better You Wellness Center | Counselor | 320 W Monroe Street, Las Vegas, NV 89106 | 2020-03-27 |
| 1730725177 | Mariah La'neese Jones | Rehabilitation Practitioner | 400 Shadow Lane Ste 106, Las Vegas, NV 89106 | 2019-11-20 |
| 1417592841 | Lourdes Rita Apumayta-paredes | Technician | 820 Rancho Lane, Suite #40, Las Vegas, NV 89106 | 2019-11-08 |
| 1902456551 | Marisela Pena | Technician | 820 Rancho Ln., 25, Las Vegas, NV 89106 | 2019-09-16 |
| 1992368724 | Amber Nicole Mahajan | Nurse Practitioner | 2020 Wellness Way, Suite 300, Las Vegas, NV 89106 | 2019-04-17 |
| 1568924215 | Arlandrea Tarvins | Behavioral Analyst | 1048 Miller Ave, Las Vegas, NV 89106 | 2019-04-02 |
| 1427510361 | Erik Pennell | Student in an Organized Health Care Education/Training Program | 1542 Pinto Ln, 2nd Floor, Las Vegas, NV 89106 | 2019-04-01 |
| 1245702729 | Bruce Mark Babb | Technician | 820 Rancho Lane Ste #40, Las Vegas, NV 89106 | 2018-12-21 |
| 1639649213 | Antonio Ruiz Pelfort | Technician | 1951 Stella Lake St Suite 36, Las Vegas, NV 89106 | 2018-11-27 |
| Find all providers in zip 89106 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.