Provider Demographics
NPI:1114063344
Name:A NEW LEAF, INC.
Entity Type:Organization
Organization Name:A NEW LEAF, INC.
Other - Org Name:A NEW LEAF, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR, CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ED
Authorized Official - Phone:208-939-3888
Mailing Address - Street 1:2428 N. STOKESBERRY PLACE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5035
Mailing Address - Country:US
Mailing Address - Phone:208-939-3888
Mailing Address - Fax:208-939-5599
Practice Address - Street 1:2548 N STOKESBERRY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1144
Practice Address - Country:US
Practice Address - Phone:208-939-3888
Practice Address - Fax:208-939-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4ANEWLEAF142251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807484600Medicaid
ID807481700Medicaid
ID807650000Medicaid