MEDICARE: GREENLEAF HEALTH CARE

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	314000000X	Skilled Nursing Facility	0016	IA
2	310500000X	Mental Illness Intermediate Care Facility	0016	IA

General Provider Information

NPI Number	:	1811945520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENLEAF HEALTH CARE

Provider Business Mailing Address
First Line	:	1305 N 22ND ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-2117
Country	:	US
Telephone Number	:	515-955-4145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 N 22ND ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-2117
Country	:	US
Telephone Number	:	515-955-4145
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	MS. JUDY A FOWLER
Credential	:	RN,NHA
Telephone Number	:	515-955-4145

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/11/2025

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Directions to “GREENLEAF HEALTH CARE ” Practice Location

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