Provider Demographics
NPI:1043605223
Name:NEW LEAF COMMUNITY WELLNESS LLC
Entity Type:Organization
Organization Name:NEW LEAF COMMUNITY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-438-5920
Mailing Address - Street 1:1070 WILEY FORK RD
Mailing Address - Street 2:
Mailing Address - City:LEBURN
Mailing Address - State:KY
Mailing Address - Zip Code:41831-8855
Mailing Address - Country:US
Mailing Address - Phone:606-438-5920
Mailing Address - Fax:
Practice Address - Street 1:1070 WILEY FORK RD
Practice Address - Street 2:
Practice Address - City:LEBURN
Practice Address - State:KY
Practice Address - Zip Code:41831-8855
Practice Address - Country:US
Practice Address - Phone:606-438-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No251S00000XAgenciesCommunity/Behavioral Health