Provider Demographics
NPI:1558039479
Name:LEAF GREEN ESSENTIAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:LEAF GREEN ESSENTIAL SOLUTIONS, LLC
Other - Org Name:LEAF GREEN MEDICAL SOLUTIONS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANEQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:615-589-0501
Mailing Address - Street 1:12004 JOURNEYS END TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2387
Mailing Address - Country:US
Mailing Address - Phone:615-589-0501
Mailing Address - Fax:
Practice Address - Street 1:12004 JOURNEYS END TRL
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2387
Practice Address - Country:US
Practice Address - Phone:615-589-0501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service