Provider Demographics
NPI:1174188205
Name:NEW LEAF DETOX AND TREATMENT
Entity type:Organization
Organization Name:NEW LEAF DETOX AND TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-CS, ICCS
Authorized Official - Phone:312-315-3315
Mailing Address - Street 1:2942 CENTURY PL # 716
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4324
Mailing Address - Country:US
Mailing Address - Phone:949-945-8391
Mailing Address - Fax:
Practice Address - Street 1:63 MALLORCA
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5625
Practice Address - Country:US
Practice Address - Phone:312-315-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility