1831636364 NPI number — A NEW LEAF THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831636364 NPI number — A NEW LEAF THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A NEW LEAF THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831636364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6597 QUIET HOURS
Provider Second Line Business Mailing Address:
APARTMENT 202
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-4943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-487-8450
Provider Business Mailing Address Fax Number:
443-692-2170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 OLNEY SANDY SPRING RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-487-8450
Provider Business Practice Location Address Fax Number:
443-692-2170
Provider Enumeration Date:
01/23/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NYBLADE
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
202-487-8450

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  18412 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 13961 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)