Provider Demographics
NPI:1659455939
Name:A NEW LEAF, INC.
Entity Type:Organization
Organization Name:A NEW LEAF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-969-4024
Mailing Address - Street 1:868 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8033
Mailing Address - Country:US
Mailing Address - Phone:480-969-4024
Mailing Address - Fax:480-969-0039
Practice Address - Street 1:960 N STAPLEY DR
Practice Address - Street 2:BUILDING 1 AND 11
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5604
Practice Address - Country:US
Practice Address - Phone:480-835-9692
Practice Address - Fax:480-835-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-5048322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-5048OtherARIZONA DEPARTMENT OF HEALTH SERVICES
AZ593584OtherAHCCCS NUMBER