MEDICARE: FREEDOM POINTE OF GREATER WEBSTER COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1013404557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM POINTE OF GREATER WEBSTER COUNTY

Provider Business Mailing Address
First Line	:	1303 A ST W STE 3
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4416
Country	:	US
Telephone Number	:	515-408-5957
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 A ST W STE 3
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4416
Country	:	US
Telephone Number	:	515-408-5957
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM COORDINATOR
Name	:	RANDALL HOOVER
Credential	:
Telephone Number	:	515-408-5917

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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Directions to “FREEDOM POINTE OF GREATER WEBSTER COUNTY ” Practice Location

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