Provider Demographics
NPI:1093833683
Name:FREEWILL FOUNDATION INC
Entity Type:Organization
Organization Name:FREEWILL FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ROACH
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-896-3777
Mailing Address - Street 1:98 S. MAIN
Mailing Address - Street 2:SUITE 2B PO BOX 177
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634
Mailing Address - Country:US
Mailing Address - Phone:435-896-3777
Mailing Address - Fax:
Practice Address - Street 1:344 N 100 W
Practice Address - Street 2:
Practice Address - City:CENTERFIELD
Practice Address - State:UT
Practice Address - Zip Code:84622
Practice Address - Country:US
Practice Address - Phone:435-896-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5966045-0142320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid