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General NPI Number Information
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NPI Number | 1174188205
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Entity Type | Organization
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Legal Business Name | NEW LEAF DETOX AND TREATMENT
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 63 MALLORCA
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5625
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Country | US
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Telephone | 312-315-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 CENTURY PL # 716
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City | COSTA MESA
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State | CA
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Zip | 92626-4324
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Country | US
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Telephone | 949-945-8391
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSHUA HAMBURG
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Credential | CADC-CS, ICCS
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Telephone | 312-315-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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