Provider Demographics
NPI:1174965370
Name:A NEW LEAF, INC. - CENTRAL CAMPUS SERVICES
Entity type:Organization
Organization Name:A NEW LEAF, INC. - CENTRAL CAMPUS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-591-5394
Mailing Address - Street 1:868 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8033
Mailing Address - Country:US
Mailing Address - Phone:480-969-4024
Mailing Address - Fax:480-969-0039
Practice Address - Street 1:960 N STAPLEY DR
Practice Address - Street 2:BUILDING 2 - 8 & 10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5604
Practice Address - Country:US
Practice Address - Phone:480-969-4024
Practice Address - Fax:480-969-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4297261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health