Provider Demographics
NPI:1003500356
Name:A NEW LEAF HOME CARE LLC
Entity Type:Organization
Organization Name:A NEW LEAF HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-618-3166
Mailing Address - Street 1:120 ACADEMY ST STE 102-099
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-1838
Mailing Address - Country:US
Mailing Address - Phone:803-618-3166
Mailing Address - Fax:
Practice Address - Street 1:120 ACADEMY ST STE 102-099
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-1838
Practice Address - Country:US
Practice Address - Phone:803-618-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Yes253Z00000XAgenciesIn Home Supportive Care