Freedom Gates Boys Ranch | |
304 N Church St Hazelton KS 67061-9300 | |
(620) 239-4031 | |
(620) 239-4032 |
Full Name | Freedom Gates Boys Ranch |
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Speciality | Clinic/center - Adolescent And Children Mental Health |
Location | 304 N Church St, Hazelton, Kansas |
Authorized Official Name and Position | Mary Freitag (CHIEF FISCAL OFFICER) |
Authorized Official Contact | 6202394031 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Freedom Gates Boys Ranch Po Box 103 Kiowa KS 67070-0103 Ph: (620) 239-4031 | Freedom Gates Boys Ranch 304 N Church St Hazelton KS 67061-9300 Ph: (620) 239-4031 |
NPI Number | 1639807324 |
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Provider Enumeration Date | 08/10/2022 |
Last Update Date | 08/10/2022 |
Certification Date | 08/10/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639807324 | NPI | - | NPPES |
1548479223 | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |