MEDICARE: A NEW LEAF, LLC

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
1	251S00000X	Community/Behavioral Health Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1700763125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW LEAF, LLC

Provider Business Mailing Address
First Line	:	5851 BURGOYNE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5103
Country	:	US
Telephone Number	:	210-578-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 BURGOYNE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5103
Country	:	US
Telephone Number	:	210-578-1509
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	DALINDA DANIELS
Credential	:
Telephone Number	:	210-578-1509

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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