Organization · NPI-2

A New Leaf

Clinic/Center, Mental Health (Including Community Mental Health Center) · Glendale, AZ

NPI number1013349570
StatusActive
Last updated in NPPESJul 31, 2024

Details

NPI
1013349570
Entity type
Organization (NPI-2)
Legal business name
A New Leaf
Organization subpart
No
Enumeration date
Aug 6, 2013
Certification date
Jul 31, 2024
Last updated
Jul 31, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
261QP2300X Clinic/Center, Primary CareOTC6465AZ

Practice location

8581 N 61st Ave Bldg A
Glendale, AZ 85302-5493

Phone 623-934-1991 · Fax 623-878-9335

Mailing address

868 E University Dr
Mesa, AZ 85203-8033

Phone 480-969-4024 · Fax 480-969-0039

Authorized official

Gracia Danis
Credentialing Specialist
5205915394

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