Provider Demographics
NPI:1659811313
Name:GREENLEAF HEALTHCARE
Entity Type:Organization
Organization Name:GREENLEAF HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-359-0094
Mailing Address - Street 1:5227 BALLARD AVE NW
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5227 BALLARD AVE NW
Practice Address - Street 2:SUITE 5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4847
Practice Address - Country:US
Practice Address - Phone:206-359-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60216753261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care