Provider Demographics
NPI:1811945520
Name:GREENLEAF HEALTH CARE
Entity type:Organization
Organization Name:GREENLEAF HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,NHA
Authorized Official - Phone:515-955-4145
Mailing Address - Street 1:1305 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2117
Mailing Address - Country:US
Mailing Address - Phone:515-955-4145
Mailing Address - Fax:
Practice Address - Street 1:1305 N 22ND ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2117
Practice Address - Country:US
Practice Address - Phone:515-955-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0016314000000X, 310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness