Provider Demographics
NPI:1881260073
Name:GREENLEAF LIVING
Entity type:Organization
Organization Name:GREENLEAF LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NKOLI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ILOANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-825-6297
Mailing Address - Street 1:5323 MACQUARIE POINT LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4795
Mailing Address - Country:US
Mailing Address - Phone:713-825-6297
Mailing Address - Fax:
Practice Address - Street 1:5323 MACQUARIE POINT LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4795
Practice Address - Country:US
Practice Address - Phone:713-825-6297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities