Healthcare Provider Details

I. General information

NPI: 1811945520
Provider Name (Legal Business Name): GREENLEAF HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N 22ND ST
FORT DODGE IA
50501-2117
US

IV. Provider business mailing address

1305 N 22ND ST
FORT DODGE IA
50501-2117
US

V. Phone/Fax

Practice location:
  • Phone: 515-955-4145
  • Fax:
Mailing address:
  • Phone: 515-955-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0016
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number0016
License Number StateIA

VIII. Authorized Official

Name: MS. JUDY A FOWLER
Title or Position: ADMINISTRATION
Credential: RN,NHA
Phone: 515-955-4145