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General NPI Number Information
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NPI Number | 1114063344
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Entity Type | Organization
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Legal Business Name | A NEW LEAF, INC.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 2548 N STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646-1144
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Country | US
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Telephone | 208-939-3888
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Fax | 208-939-5599
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Provider Business Mailing Address
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Address Line | 2428 N. STOKESBERRY PLACE
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City | MERIDIAN
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State | ID
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Zip | 83646-5035
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Country | US
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Telephone | 208-939-3888
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Fax | 208-939-5599
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Authorized Official
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Title or Position | ADMINISTRATOR, CO-OWNER
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Name | MS. AMY LYNNE WRIGHT
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Credential | MA, ED
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Telephone | 208-939-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 4ANEWLEAF142
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License Number State | ID
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