| A New Leaf, Inc | |
|
2548 N Stokesberry Pl Meridian ID 83646-1144 | |
| (208) 695-6355 | |
| (208) 939-5599 |
| Full Name | A New Leaf, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2548 N Stokesberry Pl, Meridian, Idaho |
| Authorized Official Name and Position | Brian Keith Crownover (VICE PRESIDENT) |
| Authorized Official Contact | 2086956355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A New Leaf, Inc 2428 N Stokesberry Pl Meridian ID 83646-5035 Ph: (208) 695-6355 | A New Leaf, Inc 2548 N Stokesberry Pl Meridian ID 83646-1144 Ph: (208) 695-6355 |
| NPI Number | 1629492814 |
|---|---|
| Provider Enumeration Date | 02/10/2014 |
| Last Update Date | 02/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629492814 | NPI | - | NPPES |
| 1114063344 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW-1080 (Idaho) | Secondary |
| 207Q00000X | Family Medicine | M11819 (Idaho) | Primary |
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