Provider Demographics
NPI:1891010542
Name:TURNING LEAF RESIDENTIAL REHABILITATION SERVICES
Entity Type:Organization
Organization Name:TURNING LEAF RESIDENTIAL REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:WAJIH
Authorized Official - Last Name:AL JALLAD
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:517-393-5203
Mailing Address - Street 1:P.O. BOX 23218
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:517-393-5203
Mailing Address - Fax:517-393-8968
Practice Address - Street 1:621 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6804
Practice Address - Country:US
Practice Address - Phone:517-393-5203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010968642084P0800X
MIAS330092644320800000X
MIAS330092645320800000X
MIAS330087735320800000X
MIAS3300877736320800000X
MIAS330087738320800000X
MIAS330087739320800000X
MIAM610301443320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty