Healthcare Provider Details

I. General information

NPI: 1053199331
Provider Name (Legal Business Name): GREENLEAF HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 NC HIGHWAY 55 STE 203
DURHAM NC
27713-4395
US

IV. Provider business mailing address

6409 FAYETTEVILLE RD STE 120
DURHAM NC
27713-6297
US

V. Phone/Fax

Practice location:
  • Phone: 984-480-1375
  • Fax:
Mailing address:
  • Phone: 984-480-1375
  • Fax: 984-250-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIOMBE ROBINSON-MUHAMMAD
Title or Position: OWNER
Credential: RN
Phone: 984-480-1375