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NPI Code Detail

MEDICARE: A NEW LEAF, INC. - CENTRAL CAMPUS SERVICES

MEDICARE: A NEW LEAF, INC. - CENTRAL CAMPUS SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/CenterBH4297AZ

General Provider Information

NPI Number : 1174965370
Entity Type Code : Organization
Provider Name (Legal Business Name) : A NEW LEAF, INC. - CENTRAL CAMPUS SERVICES
Provider Business Mailing Address
First Line : 868 E UNIVERSITY DR
Second Line :
City : MESA
State : AZ
Zip : 85203-8033
Country : US
Telephone Number : 480-969-4024
Fax Number : 480-969-0039
Provider Business Practice Location Address
First Line : 960 N STAPLEY DR
Second Line : BUILDING 2 - 8 & 10
City : MESA
State : AZ
Zip : 85203-5604
Country : US
Telephone Number : 480-969-4024
Fax Number : 480-969-0039
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : GRACIA DANIS
Credential :
Telephone Number : 520-591-5394
Provider Enumeration Date : 07/29/2013
Last Update Date : 07/31/2024

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Directions to “A NEW LEAF, INC. - CENTRAL CAMPUS SERVICES ” Practice Location

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