Provider Demographics
NPI:1821545013
Name:TURNING LEAF OUTPATIENT SERVICES LLC
Entity Type:Organization
Organization Name:TURNING LEAF OUTPATIENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:570-604-0324
Mailing Address - Street 1:1524 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1406
Mailing Address - Country:US
Mailing Address - Phone:570-604-0324
Mailing Address - Fax:
Practice Address - Street 1:1524 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1406
Practice Address - Country:US
Practice Address - Phone:570-604-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center