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General NPI Number Information
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NPI Number | 1619223062
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Entity Type | Organization
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Legal Business Name | GREENLEAF MANAGEMENT
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4707 GREENLEAF CT SUITE A
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City | MODESTO
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State | CA
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Zip | 95356-8733
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Country | US
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Telephone | 209-338-1550
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Fax | 209-545-2404
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Provider Business Mailing Address
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Address Line | 4707 GREENLEAF CT SUITE A
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City | MODESTO
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State | CA
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Zip | 95356-8733
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Country | US
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Telephone | 209-338-1550
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Fax | 209-545-2404
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Authorized Official
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Title or Position | CFO
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Name | JAMES DANIELS
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Credential |
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Telephone | 209-338-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | G29874
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License Number State | CA
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