Organization
NEW LEAF ADOLESCENT CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICKEY LEON RIVERS SR. (CEO)
(704) 891-5825
Entity
Organization
Contact information
Practice address
1945 J N PEASE PL STE 102, CHARLOTTE, NC 28262-4555
(704) 405-8890
(704) 405-8893
Mailing address
1945 J N PEASE PL STE 102, CHARLOTTE, NC 28262-4555
(704) 405-8890
(704) 405-8893
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
8301256B
NC
251S00000X
Community/Behavioral Health Agency
—
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-060-802
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-090-146
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060-802
—
NC
05
—
8301256B
—
NC
Enumeration date
01/17/2007
Last updated
12/04/2020
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