Organization
NEW LEAF ADOLESCENT CARE, INC
Active
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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