| Fresh Start Haven LLC | |
|
5504 41st Ave S Minneapolis MN 55417-2216 | |
| (312) 823-9296 | |
| Not Available |
| Full Name | Fresh Start Haven LLC |
|---|---|
| Speciality | Clinic/center |
| Location | 5504 41st Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Samukeliso Demadema (OWNER) |
| Authorized Official Contact | 3128239296 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Start Haven LLC 5504 41st Ave S Minneapolis MN 55417-2216 | Fresh Start Haven LLC 5504 41st Ave S Minneapolis MN 55417-2216 Ph: (312) 823-9296 |
| NPI Number | 1588546527 |
|---|---|
| Provider Enumeration Date | 07/22/2025 |
| Last Update Date | 07/22/2025 |
| Certification Date | 07/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588546527 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
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