Provider Demographics
NPI:1326200056
Name:GOLD LEAF ENTERPRISES INC
Entity Type:Organization
Organization Name:GOLD LEAF ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:COOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-243-9900
Mailing Address - Street 1:1166 GREENWAY DR
Mailing Address - Street 2:SUITE B5
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2913
Mailing Address - Country:US
Mailing Address - Phone:573-243-9900
Mailing Address - Fax:573-243-5320
Practice Address - Street 1:1166 GREENWAY DR
Practice Address - Street 2:SUITE B5
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2913
Practice Address - Country:US
Practice Address - Phone:573-243-9900
Practice Address - Fax:573-243-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO214985101YM0800X
171M00000X
MO1706830343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty