Provider Demographics
NPI:1437548823
Name:NEW LEAF RESIDENTIAL SERVICES INCORPORATED
Entity type:Organization
Organization Name:NEW LEAF RESIDENTIAL SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-793-8582
Mailing Address - Street 1:4740 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1014
Mailing Address - Country:US
Mailing Address - Phone:330-793-8582
Mailing Address - Fax:330-793-8584
Practice Address - Street 1:4740 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1014
Practice Address - Country:US
Practice Address - Phone:330-793-8582
Practice Address - Fax:330-793-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2471936Medicaid