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General NPI Number Information
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NPI Number | 1245604883
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Entity Type | Organization
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Legal Business Name | GREEN LEAF AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 2310 WHITEWOOD AVE
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City | SPRING HILL
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State | FL
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Zip | 34609-5061
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Country | US
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Telephone | 352-683-8630
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Fax | 352-683-8630
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Provider Business Mailing Address
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Address Line | 8100 WPA RD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-7056
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Country | US
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Telephone | 248-343-1695
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Fax | 352-684-4984
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Authorized Official
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Title or Position | MANAGER
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Name | ONGELIA MOORE
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Credential |
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Telephone | 248-343-1695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 11785
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License Number State | FL
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