Provider Demographics
NPI:1457856957
Name:GREENLEAF ESTATES, INC.
Entity Type:Organization
Organization Name:GREENLEAF ESTATES, INC.
Other - Org Name:FAITH'S HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRES/COO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAZETTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICHARDSON WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-371-5325
Mailing Address - Street 1:12707 MARDI GRAS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2490
Mailing Address - Country:US
Mailing Address - Phone:832-371-5325
Mailing Address - Fax:832-645-0299
Practice Address - Street 1:12707 MARDI GRAS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2490
Practice Address - Country:US
Practice Address - Phone:832-371-5325
Practice Address - Fax:832-645-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities