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NPI Code Detail

MEDICARE: A NEW LEAF, INC.

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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityBH-5048AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BH-5048OTHERAZARIZONA DEPARTMENT OF HEALTH SERVICES

General Provider Information

NPI Number : 1659455939
Entity Type Code : Organization
Provider Name (Legal Business Name) : A NEW LEAF, INC.
Provider Business Mailing Address
First Line : 868 E UNIVERSITY DR
Second Line :
City : MESA
State : AZ
Zip : 85203-8033
Country : US
Telephone Number : 480-969-4024
Fax Number : 480-969-0039
Provider Business Practice Location Address
First Line : 960 N STAPLEY DR
Second Line : BUILDING 1 AND 11
City : MESA
State : AZ
Zip : 85203-5604
Country : US
Telephone Number : 480-835-9692
Fax Number : 480-835-5457
Authorized Official
Title or Position : CEO
Name : MR. MICHAEL T. HUGHES
Credential :
Telephone Number : 480-969-4024
Provider Enumeration Date : 10/24/2006
Last Update Date : 01/04/2019

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

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