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General NPI Number Information
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NPI Number | 1144650987
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Entity Type | Organization
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Legal Business Name | NEW LEAF CENTER
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 15988B E. CHESTNUT ST.
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City | MOUNT EATON
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State | OH
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Zip | 44659-0998
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Country | US
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Telephone | 330-359-9888
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Fax | 330-359-9890
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Provider Business Mailing Address
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Address Line | PO BOX 336 15988B E. CHESTNUT STREET
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City | MOUNT EATON
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State | OH
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Zip | 44659-0336
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Country | US
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Telephone | 330-359-9888
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Fax | 330-359-9890
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, PHYSICIAN
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Name | DR. OLIVIA K WENGER
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Credential | MD
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Telephone | 330-359-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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