Healthcare Provider Details

I. General information

NPI: 1215474317
Provider Name (Legal Business Name): NEW LEAF TREATMENT CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 LAKEVIEW CIRCLE
WAHIAWA HI
96786
US

IV. Provider business mailing address

94-141 PUPUPUHI ST
WAIPAHU HI
96797-2510
US

V. Phone/Fax

Practice location:
  • Phone: 808-840-7939
  • Fax:
Mailing address:
  • Phone: 808-840-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number324500000X
License Number StateHI

VIII. Authorized Official

Name: MICHELE LEI UEMOTO
Title or Position: MEMBER/MANAGER
Credential:
Phone: 808-840-7939