Provider Demographics
NPI:1215474317
Name:NEW LEAF TREATMENT CENTRE LLC
Entity type:Organization
Organization Name:NEW LEAF TREATMENT CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEI
Authorized Official - Last Name:UEMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-840-7939
Mailing Address - Street 1:94-141 PUPUPUHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2510
Mailing Address - Country:US
Mailing Address - Phone:808-840-7939
Mailing Address - Fax:
Practice Address - Street 1:152 LAKEVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-840-7939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI324500000X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility