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Organization

A NEW LEAF, INC

Active
Parent organization
A NEW LEAF
Organization subpart
Yes

Provider details

NPI number
Legal business name
A NEW LEAF
Authorized official
DR. BRIAN KEITH CROWNOVER M.D. (VICE PRESIDENT)
(208) 695-6355
Entity
Organization

Contact information

Practice address
2548 N STOKESBERRY PL, MERIDIAN, ID 83646-1144
(208) 695-6355
(208) 939-5599
Mailing address
2428 N STOKESBERRY PL, MERIDIAN, ID 83646-5035
(208) 695-6355
(208) 939-5599

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCSW-1080
ID
207Q00000X
Family Medicine Physician
Primary
M11819
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1114063344
ID
Enumeration date
02/10/2014
Last updated
02/10/2014
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