MEDICARE: A NEW LEAF, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	4ANEWLEAF142	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114063344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW LEAF, INC.

Provider Business Mailing Address
First Line	:	2428 N. STOKESBERRY PLACE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5035
Country	:	US
Telephone Number	:	208-939-3888
Fax Number	:	208-939-5599

Provider Business Practice Location Address
First Line	:	2548 N STOKESBERRY PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-1144
Country	:	US
Telephone Number	:	208-939-3888
Fax Number	:	208-939-5599

Authorized Official
Title or Position	:	ADMINISTRATOR, CO-OWNER
Name	:	MS. AMY LYNNE WRIGHT
Credential	:	MA, ED
Telephone Number	:	208-939-3888

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	12/26/2019

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Directions to “A NEW LEAF, INC. ” Practice Location

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