Provider Demographics
NPI:1184700312
Name:COUNTY OF FREEBORN
Entity type:Organization
Organization Name:COUNTY OF FREEBORN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GABRIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-377-5116
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-1246
Mailing Address - Country:US
Mailing Address - Phone:507-377-5440
Mailing Address - Fax:507-377-5505
Practice Address - Street 1:203 WEST CLARK STREET
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-1246
Practice Address - Country:US
Practice Address - Phone:507-377-5440
Practice Address - Fax:507-377-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800854-1-MHC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30181FROtherBLUE CROSS
C0666RMedicare ID - Type Unspecified